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

BACKGROUND: The brachio-basilic vein arteriovenous (AV) fistula is increasingly used as a secondary method for haemodialysis vascular access. The conventional surgical technique of brachio-basilic vein AV fistula creation consists of a long incision with dissection of the basilic vein and transposition of it to a subcutaneous anterior position in the upper arm. The aim of this study was to investigate whether minimal invasive basilic vein dissection with an endoscopic technique is feasible.
METHODS: In 12 patients, brachio-basilic vein AV fistulas were created by means of a video-assisted technique with semi-closed dissection and harvesting of the basilic vein with the use of an endoscope and standard endoscopic instruments. All patients underwent pre- and post-operative duplex ultrasound investigation.
RESULTS: In all patients, a successful endoscopic dissection was possible without peri-operative complications. One patient suffered from post-operative thrombotic occlusion, which was successfully treated by thrombectomy. One patient developed a haematoma in the upper arm. No wound complications occurred and all AV fistulas could be used satisfactorily for dialysis treatment.
CONCLUSIONS: Video-assisted basilic vein transposition is a feasible minimal invasive technique to create secondary vascular access for haemodialysis.