Ask Dr. Z

Is this a revision? "Two small longitudinal incisions were made on the medial aspect of the upper arm, and the entire basilic vein was dissected from the PREVIOUS AV anastamosis all the way into the axilla. All branches were divided between clips or ligatures. Secondary to likely prior PICC line the basilic vein sclerosed down to nothing. Duplex was brought onto the field and a search for an axillary target was fruitless. Therefore I exposed the deep brachial vein at the mid upper arm level which was tucked behind the artery and the nerve. I used this vein as my distal target and the vein was marked and anastomosed to the deep brachial vein in an end to side fashion. Excellent flow and hemaostasis was noted and the wound closed in two layers using 3-0 monocryl and staples. The vein was not tunneled, it was merely superficialized and closed under skin flaps. Ultimately this could be used as a distal target for a forearm AVG the crosses the elbow."