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Superficialization of the venous part of a fistula is characterized by methodological diversity. Tunnel transposition and elevation are reliable procedures to maximize the availability of a deeply located autologous vein in the constructive process of an alternative form of an AVF, especially a TBBAVF. Elevation as well as lipectomy and liposuction are also utilized in revisional interventions to improve accessibility by approximating the distance from the skin to the arterialized vein.

Both careful assessment of the adaptability of superficialization and adequate comprehension of the inherent advantages and limitations of each superficialization modality will facilitate the optimal construction and maintenance of the alternative autologous AVF. This is especially important in patients who cannot undergo conventional AVF construction or in whom cannulation difficulties are encountered. Utilization of the techniques described here could lead to better outcomes and successful management of HD.