title: Operating management of central venous hypertension complicating upper extremity dialysis access.
abstract: OBJECTIVE
  To evaluate the importance of surgical bypass between the terminal part of functional arteriovenous shunt (av) for hemodialysis on upper extremity and inner jugular vein in axillosubclavian venous segment obstruction associated with central venous hypertension.
  
  
  METHODS
  Retrospective assessment of surgical bypass between central segments of av fistula and ipsilateral/contralateral inner jugular vein using ePTFE graft in 17 patients over a 20 year period (1987-2006).
  
  
  RESULTS
  The surgical procedure was not associated with intra- or post-operative complications. Primary cumulative bypass and av fistula function persisted for 26 months on average.
  
  
  CONCLUSIONS
  An accurate bypass to salvage the functional dialysis access associated with central venous hypertension requires careful decision based on clinical and radiological examination. The bypass procedure is beneficial where endovascular treatment is not indicated. Clinical and radiological bypass monitoring is crucial.
authors.affiliation: 2nd Clinic of Surgery, Teaching Hospital, Olomouc, Czech Republic. petr.bachleda@fnol.cz
authors.forename: Petr
authors.initials: P
authors.lastname: Bachleda
authors.forename: Petr
authors.initials: P
authors.lastname: Utikal
authors.forename: Lucie
authors.initials: L
authors.lastname: Kalinova
authors.forename: Petr
authors.initials: P
authors.lastname: Drac
authors.forename: Josef
authors.initials: J
authors.lastname: Zadrazil
authors.forename: Martin
authors.initials: M
authors.lastname: Koecher
authors.forename: Marie
authors.initials: M
authors.lastname: Cerna
mesh_terms: D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001367:Axillary Vein / Q000473:pathology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002496:Central Venous Pressure; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013350:Subclavian Vein / Q000473:pathology*; D014656:Vascular Surgical Procedures