When is a basilic vein ligation performed?

From the Guidelines

Basilic ligation is preferably performed in patients who have disabling AV-access complications, such as venous hypertension, recurrent stenosis requiring intervention, and/or dialysis access–associated steal syndrome, as stated in the 2023 Kidney International study 1. When considering basilic ligation, it is essential to weigh the potential benefits and risks, particularly in patients with a history of kidney transplantation or those awaiting retransplantation.

• The procedure may be necessary for patients with well-functioning transplants who experience complications related to their AV access.
• However, for retransplant candidates with an established surgical date for receiving a living-donor transplant, the need for basilic ligation may be deferred, and short-term dialysis with a tunneled catheter may be a more suitable option, as noted in the study 1.
• Patients should be encouraged to protect their fistulas after undergoing transplantation, but ongoing dialysis access maintenance procedures may not be warranted or beneficial, according to the 2023 Kidney International study 1.
• The decision to perform basilic ligation should be made on a case-by-case basis, taking into account the individual patient's medical condition, history, and potential risks and benefits, as emphasized in the study 1.

From the Research

Basilic Ligation

• Basilic ligation is not a primary topic of discussion in the provided studies, however, it is mentioned in the context of complications that can arise from basilic vein transposition for hemodialysis access 2, 3, 4, 5.
• According to the study by 5, ligation for swelling was necessary in 4 patients (2.5%) who underwent basilic vein transposition.
• The exact timing of when a basilic ligation is done is not explicitly stated in the provided studies, but it can be inferred that it is performed as a secondary intervention to address complications such as swelling or steal syndrome that may arise after basilic vein transposition.

Indications for Basilic Vein Transposition

• Basilic vein transposition is considered a viable option for patients who require long-term hemodialysis access, particularly in the absence of a suitable superficial vein 2, 3, 4, 5.
• The procedure can be performed as a primary access option or as a secondary option after failed arteriovenous access 3, 4.
• The decision to perform basilic vein transposition is typically made on a case-by-case basis, taking into account the individual patient's anatomy and medical history 2, 3, 4, 5.

Complications and Outcomes

• Complications that can arise from basilic vein transposition include arm edema, thrombosis, hematoma, infection, steal syndrome, poor flow, and aneurysm formation 2, 3, 4, 5.
• The primary patency rates for basilic vein transposition vary depending on the study, but range from 35% to 84% at one year 3, 4.
• Secondary interventions, including percutaneous and surgical revisions, may be necessary to maintain patency and address complications 5.