Brachial artery superficialization and simultaneous brachiobasilic arteriovenous fistula creation in a patient with low cardiac function

Abstract

A 56-year-old male with cardiac failure, who had started on hemodialysis, was referred to us for vascular access creation. Ultrasonography showed low cardiac function and an ejection fraction of 30%. We decided to perform superficialization of the brachial artery, but the patient did not have a percutaneous vein on his forearm or near the elbow. Therefore, we performed superficialization of the brachial artery, elevated the basilic vein, and created a brachiobasilic arteriovenous fistula in a one-stage procedure so that the mature basilic vein could be used as a vascular access site. We planned to ligate the arteriovenous fistula if the patient’s cardiac function worsened postoperatively. After the procedure, the flow rate through the brachial artery was about 1,288 mL/min, and the patient’s cardiac function was stable. The basilic vein was sufficiently mature to enable its use as a vascular access site. Although superficialization of the brachial artery is commonly recommended for patients with low cardiac function, the procedure is not usually performed in combination with the creation of a brachiobasilic arteriovenous fistula. Elevating the brachial artery and simultaneously creating a brachiobasilic arteriovenous fistula is a useful technique for patients with low cardiac function who have no available percutaneous veins.