What is superficialization?

‘Superficialization’ or ‘fistula elevation’ involves an incision from the wrist to the proximal forearm in radiocephalic fistulas, and from the antecubital fossa to the proximal upper arm in brachiocephalic or brachiobasilic fistulas.

Which type of AV access normally needs Superficialization?

Once the arteriovenous fistula is created, maturation is necessary prior to access attempts. In obese patients or those with deep veins, superficialization is often necessary to facilitate the repeated cannulation required for dialysis.

What is a brachiocephalic fistula?

The brachiocephalic fistula (Fig. 4) is an up- per arm fistula created by connecting the side of a brachial artery to the end of a cephalic vein at or slightly central to the level of the elbow.

What is Superficialization of AVF?

Superficialization of the AVF is an alternative form of VA that facilitates the construction of an autologous fistula by maximizing the availability of a deeply located vein. Superficialization is also utilized in VA revision to improve the cannulability of an arterialized vein.

What is a transposed fistula?

The arteriovenous fistula transposition is based on a first-stage proximal radial artery to median cubital vein arteriovenous fistula. Transposed brachial veins were elevated and positioned anteriorly to the incision to avoid repeated needle access through the surgical scar (Fig 2).

What are the different types of fistulas for dialysis?

Three different types of access can be placed for hemodialysis. They are called a fistula, a graft, and a catheter.

Where is the brachiocephalic vein?

The brachiocephalic veins lie in close proximately to the muscles of the inferior neck. The confluence of the subclavian vein and internal jugular vein, which form the brachiocephalic veins, are found on the medial border of the scalenus anterior muscle.

What is the most common site of stenosis in a brachiocephalic fistula?

The most common cause for a brachiocephalic fistula to fail is due to a stenosis in the cephalic arch. If neither a radiocephalic nor a brachiocephalic fistula are possible, KDOQI guidelines recommend consideration of placement of a brachial artery –to-transposed basilic vein fistula.

Where is the brachial vein?

The brachial vein is a component of the deep venous system of the upper limb. After forming from the radial and ulnar veins1, the brachial vein travels from the cubital fossa superiorly to become the axillary vein.

What is the anatomy of the cephalic vein?

The cephalic vein arises in the anatomical snuffbox from the radial side of the superficial venous network of the dorsum of the hand 2. From the radial aspect of the superficial venous network, the cephalic vein arches around the radial aspect of the forearm to course through the anterolateral forearm 1.

What is the rate of superficialization of the basilic vein?

Primary patency of basilic vein superficialization fistulas was 92%, 78%, 64%, and 54% at 1, 2, 3, and 4 years, respectively. Secondary patency was 93%, 81%, 66%, and 56% at 1, 2, 3, and 4 years, respectively. Superficialization of the basilic vein technique is a logical alternative method of the basilic vein transposition.

Is it safe to superficialize the basilic vein of the forearm?

Discussion. In conclusion, superficialization technique of the basilic vein is a logical alternative in patients with a poor cephalic vein in forearm and upper arm. This technique provides appropriate length for fistula cannulation if the superficialized vein is long. Postoperative complications are reasonable.