Forearm Vein Transposition

Brescia and Cimino et al. first described the creation of an arteriovenous fistula for hemodialysis access in 1966 [1]. Fifty years later, the National Kidney Foundation Dialysis Outcomes Quality Initiative (KDOQI) Guidelines continue to support radiocephalic arteriovenous fistula as the preferred initial vascular access [2]. Preference for a radiocephalic fistula is followed by brachiocephalic fistula, transposed brachiobasilic fistula, and lastly arteriovenous synthetic graft [2]. The overarching principal is to begin as distal as feasible and move proximally for future access procedures. The first description of a transposed upper arm brachiobasilic fistula was by Dagher et al. in 1976 [3]. Forearm cephalic or basilic vein transposition has also been described but is less commonly employed. If a forearm basilic or cephalic vein is of adequate size but anatomical constraints preclude a Cimino-type fistula, these distal transposition procedures allow for additional options. While more involved than a Cimino-type fistula, these forearm fistula options preserve upper arm veins for future procedures and may provide reliable dialysis access.