Basilic Vein Transposition

William Patrick, FRACS, Sydney, Australia

James May, MS, FRACS, Sydney, Australia

There is general agreement that a radiocephalic ar- teriovenous fistula at the wrist is the preferred method of obtaining access to the circulation. Thrombosis in the veins of the forearm from previous cannulation, however, may preclude use of this method in some patients. Under these circumstances the basilic vein is frequently spared due to its inac- cessible position. It normally runs proximally on the posterior surface of the ulnar side of the forearm and only inclines forward to the anterior surface just before the elbow. In an attempt to make use of this vein for access, Hanson et al [1] described the for- mation of an arteriovenous fistula between the basilic vein and the ulnar artery. The very position of the basilic vein which spares it from postcannulation thrombosis also renders it unsatisfactory for can- nulation after the formation of an arteriovenous fistula between the basilic vein and the ulnar artery. For this reason a technique was developed that allows both transposition of the basilic vein from the pos- terior to the anterior aspect of the forearm and anastomosis to the radial artery.

Technique

A long incision is made over the basilic vein from the elbow to the wrist (Figure 1). All tributaries of the vein are ligated together with its distal end. The vein is mobilized to the point where it is attached only at the proximal end of the wound. A 5 cm incision is made over the radii artery at the wrist. A subcutaneous tunnel is fashioned between this incision at the wrist and the incision over the basilic

From fha fhparfment of Surgery, University of Sydney, Sydney, Aus- tralia.

Raquasfs for reprints should bs addressed to James May, MS, Univarsfly of Sydney. Sydney. New south Wales 2006, Australia.

vein in the cubital fossa. Long artery forceps or a tunneller may be used for this purpose, and the same instrument is used to draw the freed basilic vein distally in the subcu- taneous channel to lie beside the radial artery. The distal end of the transposed basilic vein may be anastomosed end-to-side to the radial artery using 7-O Prolenee sutures. It is desirable that the subcutaneous channel be as super- ficial and as straight as possible to aid subsequent cannu- lation.

Comments

This technique may also be employed in patients who have had a previous radiocephalic arteriovenous fistula at the wrist with subsequent thrombosis in the cephalic vein proximal to the fistula. In this instance, the transposed basilic vein may be anastomosed ei- ther directly to the radial artery or to an arterialized vein in the vicinity. The advantages of this method are that it utilizes only autogenous tissue and avoids an incision in the leg, which must be made if the sa- phenous vein is used as an alternative source of au- togenous graft material.

Summary

A technique which enables the basilic vein to be transposed from the posterior aspect to the anterior aspect of the forearm is described. This vein may be used for access to the circulation after its anastomosis to the radial artery. The method is useful in patients who do not have a satisfactory cephalic vein.

References

1. Hanson JS, Catmody M, Keogh B, O’Dwyer WF. Access to cir- culation by permanent arteriovenous fistula in regular dialysis treatment. Br Med J 1967;4:566-9.

Figure 1. The baslik veln hrrs been freed from Its bed and ls about to be drawn thrc%@ a subcutaneous tunnel on ths anterior aspecf of tM forearm. 7lm inset shows end-to-&e anastomoek between the distal end of the basllk veln and the radial arlery at the w&t.

254 Tfm Amarfcan Journal of Surgary