Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses

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Abstract

Background:

Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion.

Methods:

We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy.

Results:

Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patients symptoms and uninterrupted patency of the pre-existing vascular access.

Conclusions:

Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.

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