title: Internal jugular to axillary vein bypass for subclavian vein thrombosis in the setting of brachial arteriovenous fistula.
abstract: Placement of central venous catheter is the most common cause of subclavian vein thrombosis. In the setting of a functioning ipsilateral brachial arteriovenous fistula, venous hypertension symptoms may be exacerbated. We report successful decompression of severe venous hypertension in the right arm of a patient whose only access for hemodialysis was a functioning right brachial arteriovenous fistula and in whom proximal subclavian vein occlusion developed from a previous percutaneous dialysis catheter. Transposition of the right internal jugular vein and end-to-side anastomosis to the right axillary vein provided prompt and effective venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of the dialysis fistula.
authors.affiliation: Division of Vascular Surgery, Massachusetts General Hospital, Boston 02114.
authors.forename: J D
authors.initials: JD
authors.lastname: Puskas
authors.forename: J P
authors.initials: JP
authors.lastname: Gertler
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001367:Axillary Vein / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D007601:Jugular Veins / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D006435:Renal Dialysis / Q000009:adverse effects*; D013350:Subclavian Vein / Q000601:surgery*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*