Objective This study aimed to evaluate the outcomes of basilic-to-fistula venovenous transposition as a salvage strategy for refractory outflow venous stenosis or occlusion in patients with end-stage kidney disease (ESKD). The study focused on assessing the technical feasibility, patency rates, and complication profiles associated with this procedure.Methods 9 cases of basilic-to-fistula venovenous transposition at a single center between December 2023 and March 2026 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods.Results The mean age of the cohort was 67.8 ± 7.2 years, with 7 males and 2 females. Renal failure was complicated with hypertension in 100%, and with diabetes in 22.2%. The average follow-up time was 16.20 ± 7.34 months. All fistulas were successfully used for dialysis within 48 hours postoperatively. The primary patency rate, primary assisted patency rate and secondary patency rate was 88.9%, 100%, 100% at 3 months, 76.2%, 87.5%, 100% at 6 months, and 63.5%, 87.5%, 100% at 1 year. 2 patients experiencing wound hemorrhage at the surgical site, and no patients developed early thrombosis, hematoma, nerve injury, wound infection, or clinically significant access-related steal.Conclusion Basilic-to-fistula venovenous transposition provides an effective autogenous solution for patients with complex ESKD access obstruction refractory to endovascular therapy. This procedure offers early functional usability, a favorable safety profile, and reduces the reintervention burden.