Vein transpositions and Grafts

Arteriovenous graft

If there are small veins that won’t develop into a fistula, a vascular access which connects an artery to a vein is created with the help of a graft or a synthetic tube implanted under the skin in your arm. The graft acts as an artificial vein that can be repeatedly used for the placement of needle and blood access during the process of hemodialysis. A graft could be used soon after placement, often within a period of 2 or 3 weeks.


Venous catheter

In certain cases, if the kidney disease has progressed rapidly, you may not get sufficient time to get a permanent vascular access before the treatment begins. In such conditions, you may have to use a venous catheter as a temporary access.

A catheter is basically a tube which is inserted into a vein in your neck, chest, or leg near the groin. A catheter comprises two chambers that enable a two-way flow of blood. Once a catheter is in place, needle insertion is not required.

However, catheters are not suitable for permanent access. They can get clogged, become infected, and even result in the narrowing of the veins in which they are placed. But if hemodialysis has to be started immediately, a catheter can be used. It can function properly for several weeks or months.

Every hemodialysis session makes use of an AV fistula or an AV graft that necessitates needle insertion. Most often two needles are used; one to transport blood to the dialyzer and one to return the purified blood to your body. If you want to do hemodialysis at home, then you should be precisely aware of the various needle insertion techniques and the treatment methods

Vein transpositions

For patients who require hemodialysis, a properly functioning vascular access is crucial for achieving optimal quality of life. If a suitable cephalic vein at the forearm and upper arm cannot be found, an arteriovenous fistula (AVF) is made using a prosthetic graft or a transposed basilic vein. The basilic vein is completely protected from venipuncture owing to its deep position in the subfascial plane.

Basilic vein transposition (BVT) was first performed in 1976 and is considered a viable option for secondary or tertiary vascular access. Fistulas made with a transposed basilic vein have been found to be the most reliable secondary vascular access procedure for chronic hemodialysis.

Conventional BVT

In Conventional Basilic vein transposition (BVT), a long incision is made over the medial aspect of the arm. The basilic vein is dissected up to the axillary vein and transposed into the subcutaneous tissue using multiple small incisions. End to side basilic vein brachial artery anastmosis is then performed.

Transposition of basilica vein with minimal incision

In this process, which is performed under local anesthesia, a transverse skin incision is made on the antecubital area to identify a basilic vein and brachial artery. Following this, three or four longitudinal skin incisions are made along the basilic vein. The basilic vein is then pulled out toward axillary region. With the help of a tunneler, tunneling is performed under the skin and the full length of the basilic vein is transpositioned towards the lateral side of the upper arm. Then, end to side basilic vein brachial artery anastmosis is done. Small incision or minimal incision applied to basilic vein transposition can lessen the pain and will be more comfortable to the patients.