title: Extending outflow brachial vein length for transposition arteriovenous fistulas.
abstract: OBJECTIVE
  Transposition arteriovenous fistulas (T-AVF) play an important role in establishing autogenous vascular access for many hemodialysis patients. When the basilic vein is not available, one of the paired brachial veins offers a reliable T-AVF option, generally as a two-staged operation. Uncommonly, the brachial vein outflow conduit dissipates into multiple small branches communicating with the paired brachial vein or occasionally with a residual proximal segment of the basilic vein. We utilized parallel outflow vein component segments to create additional outflow vein length necessary for successful T-AVFs in these patients.
  
  
  METHODS
  We identified four patients where a vein length extension technique utilizing parallel and overlapping vein segments with an end-to-end anastomosis gained adequate length for successful T-AVFs. All transpositions were based on a first stage AVF with access outflow established into a brachial vein.
  
  
  METHODS
  Three of the operations utilized paired brachial vein segments and one gained needed access outflow length with a brachial vein anastomosis to a residual proximal basilic vein segment. All four patients had functional T-AVFs at 4, 5, 7, and 14 month follow-up. None of the patients developed arm swelling.
  
  
  CONCLUSIONS
  Creating a longer transposition AVF venous outflow segment using parallel and overlapping vein segments with an end-to-end anastomosis gained the adequate length needed for successful T-AVFs in these four patients.
authors.affiliation: Department of Surgery, School of Community Medicine, University of Oklahoma-Tulsa, Tulsa, OK, USA. William-jennings@ouhsc.edu
authors.forename: William C
authors.initials: WC
authors.lastname: Jennings
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Howard
authors.forename: Fred S
authors.initials: FS
authors.lastname: Lee
authors.forename: Dirk
authors.initials: D
authors.lastname: McMurray
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery