Video-assisted basilic vein transposition for haemodialysis vascular access: preliminary experience with a new technique

Background. The brachio-basilic vein arteriovenous (AV) fistula is increasi ngly used as a secondary method for haemodialysis vascular access. The conv entional surgical technique of brachio-basilic vein AV fistula creation con sists of a long incision with dissection of the basilic vein and transposit ion of it to a subcutaneous anterior position in the upper arm. The aim of this study was to investigate whether minimal invasive basilic vein dissect ion with an endoscopic technique is feasible. Methods. In 12 patients, brachio-basilic vein AV fistulas were created by m eans of a video-assisted technique with semi-closed dissection and harvesti ng of the basilic vein with the use of an endoscope and standard endoscopic instruments. All patients underwent pre- and post-operative duplex ultraso und investigation. Results. In all patients, a successful endoscopic dissection was possible w ithout peri-operative complications. One patient suffered fi um post-operat ive thrombotic occlusion, which was successfully treated by thrombectomy. O ne patient developed a haematoma in the upper arm. No wound complications o ccurred and all AV fistulas could be used satisfactorily for dialysis treat ment. Conclusions. Video-assisted basilic vein transposition is a feasible minima l invasive technique to create secondary vascular access for haemodialysis.