Deep Brachial Vein Transposition Arteriovenous Fistula

Abstract

Deep brachial veins are deep veins accompanying the deep brachial artery, and are rarely used for the creation of an arteriovenous fistula (AVF) for hemodialysis. We herein report a case of the creation of a transposed deep brachial vein arteriovenous fistula in an end-stage renal failure patient with inadequate superficial veins in the upper limbs. A 59-year-old woman with end-stage renal failure undergoing hemodialysis, who had previously had an AVF created at the left antecubital fossa and who required repeated vascular access intervention therapies, was admitted to our hospital because of the formation of a pseudoaneurysm of the deep brachial vein, which was being used as an AVF. We first tried to repair the AVF by creating a basilic vein transposition AVF, but this procedure failed. As the deep brachial vein was well-developed, we decided to create a transposed deep brachial vein AVF to avoid the complications associated with creating an arteriovenous graft. The anastomosis of the previous AVF at the antecubital fossa was preserved. The deep brachial vein was freed and ligated distally. The freed deep brachial vein was transposed subcutaneously at the site of the anterior upper arm, and was anastomosed to the brachial vein. No complications other than occasional edema were seen, and the AVF was still patent 12 months postoperatively.