Transposition of the cephalic vein in therapeutic rescue. A reliable secondaryaccess procedure article pdf available in archives of surgery 18. Our aim was to report on a randomized controlled trial comparing these two techniques. If the nerve branch entangled the basilic vein and impeded its anterior transposition, the nerve was carefully split between its major fascicles with blunt and sharp dissection to facilitate the transposition video, online only. Basilic vein transposition is recommended in patients who are not candidates for a radial or brachial artery to cephalic vein fistula for dialysis access. This can either be a native connection or a connection using a ptfe polytetrafluoroethylene graft.
To compare the outcome of the onestage basilic vein transposition bvt fistula with a modified, twostage technique. The original technique of brachiobasilic av fistula construction is a twostep approach. The basilic vein drains the medial side of the superficial venous network of the dorsum of the hand, which in turn drains blood from the palm of the hand 2. End to side basilic vein brachial artery anastmosis is. One of the veins used for an avf is the basilic vein, located at the upper arm. It is a method of forming an avf by transposing the basilic vein from a deep location in the medial site of upper arm to a shallow position.
Three additional patients underwent exploration of an inadequate basilic vein with subsequent prosthetic grafting. A, basilic vein mobilized from the proximal forearm to its junction with the axillary vein. However, when other simple fistula options are exhausted, the basilic vein. Upper arm basilic vein elevation as a solution for forearm. If it is not possible to create either of these fistulae, access may be established using a basilic vein transposition avf brachial arterybasilic vein or other avf configuration such as a brachial vein transposition avf brachial arterybrachial vein.
Basilic vein transposition used as a tertiary vascular. Pdf randomized controlled trial comparing primary and. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. Once it is felt that further dissection was not possible from this incision, another cm longitudinal incision in the medial aspect of the upper arm and dissection of the basilic vein continued absilic. The brachial artery transposed basilic vein arteriovenous fistulas have been used as a primary, secondary. Transposed brachiobasilic vein fistula maturation rate after primary procedures 39, 33% was lower compared to maturation rate after. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. My surgeon does a vein transposition as a staged procedure after creating a direct anastomosis. Basilic vein definition and meaning collins english. Current procedural terminology arteriovenous anastomosis. Upper arm basilic vein transposition for hemodialysis.
Materials and methodbetween january 2000 and december 2010, consecutive patients undergoing bc or bvt avf were included. An upper arm avf is typically created at the antecubital fossa and connects the brachial artery to the cephalic vein or at the basilic vein, which is usually transposed more anterolaterally for. To improve the results of bvt, several technical modifications have been proposed, including procedure staging,5, 7 endoscopic basilic vein dissection, 6 partial basilic vein mobilisation,8, 11 superficialisation instead of formal transposition, 9 basilic vein dissection through skip incisions and transposition in onestage procedure 10 and. Av fistula with interposition graft general surgery coding. Transposed basilic vein according to our centers surgical. To modify the technique of basilic vein transposition for vascular accesss for haemodialysis aiming at better maturation rate, longer survival of fistula and lesser complications. Utility of basilic vein transposition for dialysis access. Basilic vein transposition with bbavf creation youtube. Furthermore, two of the three patients in whom the fistula could not be constructed were found at a later procedure to have an adequate contrallateral basilic vein and underwent autogenous fistula construction of the opposite arm. The conventional bvt requires long incision over the medial aspect of the arm to dissect the basilic vein up to axillary vein. An acquired arm arteriovenous fistula avf creation is a procedure performed for haemodialysis access in those with end stage renal failure.
It originates on the medial ulnar side of the dorsal venous network of the hand and travels up the base of the forearm, where its course is generally visible through the skin as it travels in the subcutaneous fat and fascia lying superficial to the muscles. This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. Transposition of basilic vein with minimal incision. In this report, the rates of primary and primary assisted patencies are lower than the rates reported throughout the literature. To study the place of basilic vein transposition in providing longterm vascular access for patients needing longterm hemodialysis. Methodsin onestage bvt, the basilic vein is mobilised through a single.
The aim of this paper was to present our 3year multicenter experience in creating a vascular access using the basilic vein. The basilic vein terminates by uniting with the paired brachial veins to form the axillary vein at the inferior border of the teres major muscle 4. The result, in our population, was the demonstration that the basilic vein was often the only autologous conduit available of adequate size at least 3. This vein is however deeply located and necessitates transposition during surgery to a less deep and lateral subcutaneous plane before the anastomosis with the artery, in order to be used. These keywords were added by machine and not by the authors. Basilic vein thrombosis bvt it is a special kind of deep vein thrombosis. Conventional basilic vein transposition bvt conventional bvt figure 1 requires long incision over the medial aspect of the arm.
Most of the patients these veins are preserved and it has a very good. A viable alternative for multiple failed arteriovenous fistulas a single center experience. Transposition of basilic vein with minimal incision journal. This is a temporary file and hence do not link it from a website, instead link the url of this page if you wish to link the pdf file. This results in dilatation and wall thickening of the vein, allowing for frequent cannulation for hemodialysis. In onestage procedures, the basilic vein is usually mobilised through a singlearm incision along the course of the basilic vein fig. Objectiveit is unclear if brachio basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. Basilic vein transpositions are always the best option in the obese david fox, md, facs vascular surgeon north shore lijlenox hill hospital disclosures. It is then cut in the cubital fossa and transposed into the subcutaneous tissue by multiple small incisions to perform the end to side basilic vein brachial artery anastomosis. After dissecting the basilic vein up to axillary vein, it is cut in the cubital fossa and transposed into the subcutaneous tissue by multiple small incisions. Dec 06, 2017 patient with chronic renal failure who has no other veins left for av access is best treated with basilic vein transposition. This process is experimental and the keywords may be updated as the learning algorithm improves. Haemodialysis arteriovenous fistula radiology reference. Basilic vein transposition is a feasible and a good method to make avf with autogenous vein.
Cpt 36819 appropriate to code for basilic vein transposition arteriovenous fistula anastomosis. Retrospective casecontrolled study, performed in an academic centre. Designretrospective casecontrolled study, performed in an academic centre. The transposed basilic vein avf was technically feasible in 95% of cases, can frequently. Can i bill the transposition as a staged procedure. All methods attempt to place the fistula approximately 6 mm beneath the skin for ease of dialysis access. Minimally invasive basilic vein transposition in the arm. A modified technique of basilic vein transposition for haemodialysis farid ahmad chaudhary1 and zahid parvez2 abstract objective. This would require a long incision to gain access and mobilise the basilic vein making sure the anastomosis is not placed under tension and no obvious stenosis is present proximally. Mar 28, 2020 the basilic vein runs down the ulnar side of the arm, and also helps in draining the dorsal venous network of the hand. The purpose of this study was to compare ptfe arm graft with superficialized basilic vein as a secondary vascular access for hd. Acraiumsru practice parameter for the performance of. The basilic vein and the cephalic vein perform equally in. Basilic vein transposition journal of vascular surgery.
Patient with chronic renal failure who has no other veins left for av access is best treated with basilic vein transposition. A modified technique of basilic vein transposition for. If a leak is present it needs to be sealed either in the form. Utility of basilic vein transposition for dialysis. Basilic elevation transposition may improve the clinical. This can either be a native connection or a connection usi. Small incision can be applied to basilic vein transposition, which can be less painful and more comfortable to the patients. Transpositioned basilic veins were well matured enough to dialysis. The upper arm basilic vein is usually inaccessible for dialysis cannulation because of its medial and deep position.
Hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. See essential instructions from icd10pcs official guidelines for coding and reporting right on your code details page. A good alternative to standard method endstage renal disease is a significant health problem. Request pdf small incision basilic vein transposition technique. Hemodialysis is a necessary treatment for life in patients with chronic renal failure when peritoneal dialysis and renal transplantation can not be an option.
Trial comparing onestage with twostage basilic vein. Arteriovenous fistula using basilic vein transposition. Brachiobasilic arteriovenous fistula, or basilic vein transposition bvt, is frequently used in hemodialysis access with the benefit that the basilic vein is typically of a larger size than its companion, the cephalic vein. Transposition of brachial vein is an alternative to arteriovenous graft.
The basilic vein is a large superficial vein of the upper limb that helps drain parts of the hand and forearm. In this study, the results of basilic vein transposition bvt procedures performed in our clinic for hemodialysis were retrospectively analyzed. The patient who experienced primary failure is being assessed for surgical suitability for a basilic vein transposition procedure two previous av access failures and a history of central stenosis, and the second patient is being assessed for a transposed basilic vein fistula, pending investigation of hypercoagulability two previous av access failures. Renal failure patients need a good av access for hemodialysis. Ambarish satwik, ajay yadav, sandeep agarwal, varinder singh bedi 2018, outcomes of basilic vein transposition at 1 year of followup, indian journal of vascular and endovascular. Randomized controlled trial comparing primary and staged basilic vein transposition. C, basilic vein is brought through the tunnel and anastomosed end to side to the brachial artery. No need to flip from a code to the front of a book or to hunt through online pdfs to locate applicable chapter and block specific guidelines.
Transposed basilic veinbrachial arteriovenous fistula. What on earth are all of those operations what incisions are involved, and. A basilic vein transposition elevation procedure was performed in the upper arm starting at the level of the elbow to a few centimeters below the axilla. The basilic vein transposition was the initial angioaccess procedure in only 25% of cases and secondary in 75%. B, subcutaneous tunnel is created over the anterior upper arm. The basilic vein in the medial aspect of the upper arm is the most common deep vein utilized for arteriovenous fistula creation. Branches of the dilated basilic vein were ligated, the median cutaneous nerve was preserved, and the vein was elevated from its native position to a superficial and anterior location. In this procedure, the provider creates an arteriovenous anastomosis, by connecting the basilic vein to the brachial artery in the arm to provide better vascular access in patients with kidney failure who will receive hemodialysis treatment. The conventional surgical technique of basilic vein transposition consists of dissection and.
Short axillary vein and an axillary venous ladder formed by. It is shorter than the cephalic vein, and terminates once it joins the brachial vein near the elbow. This is a common disease that affects the basilic vein. Most of the patients these veins are preserved and it. Apr 03, 2020 the doqi guidelines acknowledge the problems with basilic vein transposition bvt as two.
Abstractobjectivesto compare the outcome of the onestage basilic vein transposition bvt fistula with a modified, twostage technique. The basilic vein pierces the deep fascia at the elbow and joins the venae commitantes of the brachial vein to form the. Jul 11, 2011 the vein moves up and meets the cephalic vein that is situated close to the elbow. Upper arm basilic vein transposition fistula is an excellent tertiary autologous vascular access after radiocephalic and brachiocephalic fistula. Small incision basilic vein transposition technique. It is unclear if brachio basilic vein fistula should be performed as a primary or staged procedure, particularly for smaller basilic veins. This finally drains and transports large amounts of blood to the heart from the limbs. This series documents an excellent vein utilization rate of 95%.
Basilic vein transpositions are always the best option in. Randomized controlled trial comparing primary and staged. The option for cephalic vein transposition cvt, described by chen et al. The anatomy of the basilic vein in the arm is described. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. Yes, you can bill the vein transposition 36819, arteriovenous anastomosis, open. Pdf brachiobasilic arteriovenous fistula with transposition of the. A comparative analysis, which included the number of valves and measurement of the diameter of the basilic vein at three different points in the arm, was done. The basilic vein is mobilized from its usual location and transposed superficially through the deep fascia in the upper arm to create the transposed basilic vein arteriovenous fistula. A good alternative to standard method muthu veeramani, jigish vyas, ravindra sabnis, mahesh desai department of urology, muljibhai patel urological hospital, nadiad, gugarat 387 001, india. Though basilic vein transposition is well established in multiple failed fistulaes and obese patients, it requires large incision and morbidities like edema and. Basilic vein transposition pdf basilic vein transposition bvt fulfills the need for a durable conduit with high patency and maturation rates.
Basilic definition and meaning collins english dictionary. Arteriovenous fistula using transposed basilic vein. Pdf the increasing survival of hemodialysis patients results in the depletion of superficial venous capital. Materiala total of 173 candidates for bvt fistula 87 males, mean age 61 years. Frontiers randomized controlled trial comparing primary. The basilic vein is disconnected and dilated with hepari.
I might place a forearm loop graft, but i may have to do a basilic vein transposition if the cephalic doesnt match up sizewise to the gore tex. The brachial arterytransposed basilic vein arteriovenous fistula has been used in preference to a prosthetic graft on 31 occasions. When simple rcavf or bcavf is not possible due to poor quality veins or previous failures, we do basilic vein transposition. It originates on the medial side of the dorsal venous network of the hand and travels up the base of the forearm, where its course is generally visible through the skin as it travels in the subcutaneous fat and fascia lying superficial to the muscles. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula bavt provides autologous choice for hemodialysis. Therefore, the basilic vein needs to be superficialized and transposed to an anterolateral position.
The surgical procedure entailed transecting the healthy portion of the cephalic vein distal to the stenotic segment in the arch, transposing and anastomosing it to the upper basilic 2. Randomized controlled trial comparing primary and staged basilic. Abstractobjectiveto compare the brachiocephalic bc and basilic vein transposition bvt arteriovenous fistula avf with regard to maturation, patency, blood flow and complication rates. One or twostage basilic vein transposition fistula. Arteriovenous fistula using transposed basilic vein is a suitable procedure that should be considered as one of the options for longterm vascular access in patients with chronic renal failure requiring hemodialysis.
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