Surgical Management of Deep Fistula Veins

Deep veins are increasingly used for creations of arteriovenous fistulas. Not uncommon in patients with chronic kidney diseases, the cephalic veins are too small or have been damaged by repeated phlebotomy or cannulations or have been used for arteriovenous access. In these patients, the usually undamaged basilic veins become preferred for arteriovenous fistula creations [1]. However, the basilic veins usually cannot be cannulated directly and require transposition before use. Additionally, the prevalence of obesity is increasing, causing the cephalic veins too deep for direct cannulations. These deep veins pose additional challenges for creating functional autogenous arteriovenous fistulas. The goal of surgical management is to render these fistula veins easily cannulatable for hemodialysis therapy.