Use of the internal mammary vein for access outflow in a hemodialysis fistula.
A patient with occlusion of multiple central veins from both dialysis and nondialysis catheters required permanent access for hemodialysis. Magnetic resonance imaging showed a patent left innominate vein. He underwent creation of a left axillary artery to internal mammary vein transposition fistula using the basilic vein from his right arm. The fistula has required one revision for outflow stenosis and one for aneurysmal degeneration. It continues to function well 3 years after placement. The internal mammary vein is an option for outflow when permanent hemodialysis access has failed in the presence of a patent innominate vein with occluded or severely stenotic ipsilateral subclavian and jugular veins.
Jaffers
Gregory J
GJ
Division of Transplantation Surgery, Scott and White Hospital, Temple, TX 76502, USA. gjaffers@swmail.sw.org
Reiter
Charles
C
Buckley
Clifford J
CJ
D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001366:Axillary Artery / Q000601:surgery; D006801:Humans; D007601:Jugular Veins / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D013350:Subclavian Vein / Q000473:pathology; D013909:Thorax / Q000098:blood supply*; D014680:Veins / Q000601:surgery