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Non-ligation of the distal cephalic vein maintains patency of median cubital vein arteriovenous fistulae.

The utilisation of the median cubital vein is a recognised technique for upper arm arteriovenous fistula formation. In our experience, when the median cubital vein is suitable for arteriovenous fistula formation, the distal cephalic vein should not be ligated and divided. By preserving the continuity of the cephalic vein, venous drainage from the forearm will maintain patency of the cephalic vein in the arm in the event of median cubital vein occlusion secondary to anastomotic intimal hyperplasia. Furthermore, if the fistula is ligated following transplantation, cephalic vein drainage is preserved allowing the future formation of a brachiocephalic fistula. 
 
 
 
Figure 1 
 
(A) Pre-operative anatomy. (B) Postoperative anatomy, cephalic vein left in continuity. (C) Postoperative anatomy, cephalic vein ligated.