title: Salvage of a dialysis angioaccess by bypassing a central venous obstruction to the common femoral vein.
abstract: We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.
authors.affiliation: Klinik für Gefässchirurgie, St. Josef Hospital, Ruhruniversität Bochum, Germany. hasci@tin.it
authors.forename: G
authors.initials: G
authors.lastname: Asciutto
authors.forename: A
authors.initials: A
authors.lastname: Mumme
authors.forename: K Ch
authors.initials: KCh
authors.lastname: Asciutto
authors.forename: B
authors.initials: B
authors.lastname: Geier
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001367:Axillary Vein / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D008297:Male; D010690:Phlebography; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D006435:Renal Dialysis; D016879:Salvage Therapy; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014690:Venous Pressure
chemical_list: D011138:Polytetrafluoroethylene