A short description regarding Basilic Vein Transposition for postgraduates

1. Basilic Vein Transposition
- Dr. Nipun Bansal
Senior Resident
Department of General Surgery
Government Medical College & New Civil Hospital
Surat, Gujarat, India

2. Introduction to BVT
 In dialysis dependent ESRD patients, ARTERIO-VENOUS ACCESS is the
chief mode of hemodialysis.
 BVT is an AUTOGENOUS AV fistula
 alternative in patients with MULTIPLE FAILED AV ACCESS.
 Lower infection rate and longer patency than PTFE
 First described by Dagher in 1976.
Order of preference: (acc to DOQI)
Radial artery-cephalic vein WRIST fistula ( Brescia-Cimino)
Brachio-Cephalic AV fistula
Brachio-Basilic AV fistula with Basilic Vein Transposition (BBAVF + BVT)
Prosthetic graft e.g PTFE

4. Pre-operative
 History & Clinical Examination
 Exclude arterial disease / ischemic changes
 Poor flow
 Infection
 Co-morbid illness : Majority - DIABETES
 Previous h/o fistula creation
 Previous h/o dialysis catheter insertion.
 Duplex Scanning
 Basilic vein diameter: Antero-posterior internal diameter of basilic vein using B-Mode
Technique.
 Veins >2.5mm diameter are suitable.
 Pre-operative Vein Mapping and Vein Marking on skin Surface-
 Assessment of Patency of vein
 Precise Incision Placement

5. Procedure
 Regional Anesthesia (brachial plexus block) / LA
 Basilic vein & brachial artery are marked at cubital fossa using duplex imaging.
 Mobilisation of basilic vein from cubital fossa to axillary vein.
 Dissection of brachial artery.
 Hydrostatic Dilatation of Basilic vein done.
 Distended vein is draped over upper arm in an Arc.
 Future course of transposed vein is marked on skin.
 Dilated vein is TUNNELED Sub-dermally.
 Fistula created end-to-side using PROLENE 6-0.
 “Thrill” confirmed.
 Closed suction drain placed in bed of basilic vein harvest & brought out
through separate stab wound.

7. Post-operative Care
 Maturation time of min 4 weeks before used for dialysis.
 Oral Aspirin 75 mg / day * 1 month
 Follow up visits

8. Complications
1. Fistula Thrombosis - Most Common
2. Limb edema
3. Wound infection
4. Technical failure e.g Kinking/ twisting of the vein
5. Hematoma
6. Pseudoaneurysm
7. Steal Syndrome
8. Stenosis

9. Interventions
- done in about 25- 30 % of cases
Complication Intervention
Fistula Thrombosis Thrombectomy
Balloon Angioplasty
Central venous Stenting
Limb edema Limb elevation
Pseudoaneurysm Repair
Technical Failure Fistula Revision

10.  PRIMARY PATENCY RATE slightly higher than the Secondary Patency rate
BVT is a feasible, suitable surgical option to provide
- durable and autogenous AV access
- to ESRD patients requiring Maintainence hemodialysis
- if other superficial veins of upper limbs are not available.

11. tHanKs !!
Dialysis
Machine
Transposed
Vein
AV Fistula for Hemodialysis
tHanks
Have a Good Day
: Dr. Nipun Bansal