Internal jugular to axillary vein bypass for subclavian vein thrombosis in the setting of brachial arteriovenous fistula.
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.
Puskas
J D
JD
Division of Vascular Surgery, Massachusetts General Hospital, Boston 02114.
Gertler
J P
JP
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*