Vein transpositions and Grafts

Arteriovenous graft

If there are small veins that won’t develop into a fistula, a vascular access that 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.

Vein-transpositions-and-Grafts

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.

Vein transpositions and Grafts

Transposition of basilica vein with minimal incision

In this process, which is performed under local or regional 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.