Basilic Vein Transposition

The upper arm brachiobasilic fistula—brought to the surface, hence often called basilic vein transposition (BVT), is viewed by some as a “complex” fistula. This has, however, the highest maturation rate of any form of access, between 80% and 90%. Surgeon skill and type of transposition are perhaps more important to success than with any other form of hemodialysis access. It is postulated that three critical concepts be followed to correctly create this access: First, the basilic vein must be of adequate length to allow transposition to a position on the anterior aspect of the upper arm where cannulation can be easily accomplished. Second, the vein should be truly transposed rather than merely superficialized, and third, the “swing point” in the axilla should be fully dissected free, and all tethering must be eliminated to avoid stenosis of the swing segment. It is suggested that a surgeon making use of this option achieve maturation rates, no matter the technique of strategy, with all patients entering the pathway considered, of at least 80%. In addition, most patients should be cannulated within 8 or 9 weeks of their first operation.