Axillary to saphenous vein bypass for treatment of central venous obstruction in patients receiving dialysis.
OBJECTIVE
Venous hypertension due to subclavian or innominate vein stenosis coexisting with a functioning arteriovenous access in the ipsilateral arm is a complex problem in patients undergoing hemodialysis. Therapeutic solutions must optimally relieve symptoms, permit use of the angioaccess, and carry minimal surgical risk. The purpose of this study was to evaluate a simple surgical option, bypassing central venous obstruction to the great saphenous vein.


METHODS
Eight patients undergoing hemodialysis with severe symptoms and signs of venous hypertension due to subclavian or innominate vein obstruction and ipsilateral arteriovenous fistula or graft underwent axillosaphenous bypass via a subcutaneous 8-mm polytetrafluoroethylene bridge graft.


RESULTS
No intraoperative or immediate postoperative morbidity was observed. Early and 6-month patency rates were 100% and 87.5%, respectively. All patients reported improvement of symptoms, and the angioaccess was usable in all cases. Average follow-up was 21.5 months. One patient had a relapse at 5 months, which necessitated revision of the graft-saphenous vein anastomosis.


CONCLUSIONS
Bypassing a central vein occlusion to the saphenous vein relieves symptoms of venous hypertension and prolongs use of the hemodialysis angioaccess.
First Department of Surgery, General Regional Hospital Nikea. cbelessi@otenet.gr
Nikos
N
Kavallieratos
Antonios
A
Kokkinos
Petros
P
Kalocheretis
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001367:Axillary Vein / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000601:surgery*; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome