VEIN TRANSPOSITION IN THE FOREARM FOR AUTOGENOUS HEMODIALYSIS ACCESS

Purpose: We describe a technique of superficial venous transposition i n the forearm used for the formation of an arteriovenous fistula for h emodialysis access. These modifications of the single-incision radioce phalic fistula are designed to increase options for arteriovenous fist ulas by using veins and arteries that are suitable for use but are not in immediate proximity. Methods: Arteries and veins suitable for a pr imary arteriovenous fistula were identified and mapped using duplex ul trasound in 89 patients. Separate incisions were used in the majority of cases, and the selected forearm vein was mobilized, angiodilated, a nd transposed into a subcutaneous tunnel on the volar aspect of the fo rearm. Before initiation of hemodialysis, duplex ultrasound scanning w as performed, and the location that was most suitable for cannulation was identified. Repeat scans were performed at 3-month intervals for a nalysis of patency. Results: Superficial venous transpositions were pe rformed using a single incision in 13 instances in which the vein was in immediate proximity to the radial artery (type A). Dorsal-to-volar forearm transposition (type B) was performed in 30 veins with anastomo ses to the radial (n = 26), ulnar (n = 2), or brachial (n = 2) arterie s. Volar-to-volar forearm transposition (type C) was performed in the remaining 46 veins, with anastomoses to the radial (n = 42), ulnar (n = 2), or brachial arteries (n = 2). Successful hemodialysis was accomp lished in 81 of 89 patients (91%). The primary cumulative patency rate was 84% at 1 year and 69% at 2 years. The mean duration of follow-up was 14.3 months. Conclusions: The use of superficial venous transposit ion for the formation of autogenous hemoaccess was associated with eas e of cannulation by dialysis personnel, high maturation rates, reduced early failure rates, and enhanced patency rates. We recommend the use of these technical modifications to increase the use of autogenous fi stulas in the forearm.