From the Guidelines
Transposing a long length of the basilic vein for dialysis is necessary to facilitate easy access and ensure proper maturation of the vein for repeated hemodialysis sessions. This procedure is crucial because the basilic vein is naturally located deep in the arm, making it difficult to access repeatedly for hemodialysis. The basilic vein transposition is typically performed when other options like radiocephalic or brachiocephalic fistulas are not viable due to small or damaged vessels, as suggested by the KDOQI clinical practice guideline for vascular access: 2019 update 1.
According to the guideline, the brachiobasilic arteriovenous fistula (AVF) is a recommended option for vascular access creation, especially when considering the patient’s circumstances, available suitable vessels, and ESKD Life-Plan 1. The procedure involves surgically moving (transposing) the vein from its deep position to a more superficial location under the skin, where it can be easily accessed with dialysis needles. This transposition allows the vein to mature properly by developing thicker walls and increased diameter, which are essential characteristics for a functional dialysis access.
Some key points to consider when performing a basilic vein transposition include:
- The need for a significant length of the vein to be mobilized (usually 15-20 cm) to create an adequate segment for repeated needle insertions during dialysis sessions
- The typical 6-8 week maturation period required before the vein can be used for dialysis
- The potential benefits of this approach, including better long-term patency rates compared to synthetic grafts and reduced complications like infections and thrombosis, as supported by the KDOQI guideline 1.
Overall, transposing a long length of the basilic vein for dialysis is a crucial step in ensuring the creation of a functional and long-lasting vascular access for patients requiring hemodialysis.
From the Research
Necessity of Transposing the Basilic Vein for Dialysis
The basilic vein is often transposed to create an arteriovenous fistula (AVF) for hemodialysis access when other options are not available. This procedure is considered necessary for several reasons:
- To extend the availability of each extremity as an access site, allowing for multiple procedures to be performed on the same arm 2
- To provide a suitable alternative to prosthetic dialysis angioaccess, which can have higher complication rates and lower patency rates 2, 3
- To increase the length of the basilic vein available for cannulation, reducing the risk of puncture-related pseudoaneurysms and improving fistula longevity and functionality 4
Benefits of Basilic Vein Transposition
The benefits of transposing the basilic vein for dialysis access include:
- High maturation rates, with one study reporting a maturation rate of 85.7% 3
- Good long-term patency rates, with primary patency rates ranging from 49% to 84% at one year 2, 3, 5
- Low complication rates, with the most common complications being edema, thrombosis, and infection 3, 5
- The ability to perform the procedure in a single stage, reducing the need for multiple surgeries 5
Indications for Basilic Vein Transposition
Basilic vein transposition is indicated in patients who: