title: Combined femoral vein transposition and iliac vein to suprarenal vena cava bypass as a last resort dialysis access.
abstract: Patients undergoing hemodialysis are known to develop central venous occlusion and exhaust all options for vascular access to upper extremity sites; therefore, creating and maintaining vascular access is paramount in such patients. The present case report describes the condition of a 34-year-old woman with failed upper extremity access, frequent catheter-related issues, and multiple central venous occlusions. As a last resort, access to the lower extremity was pursued as follows: an inferior vena cava bypass was combined with a right femoral transposition fistula and a distal revascularization interval ligation procedure. This complex procedure that was carried out for the purpose of vascular access is a unique, albeit aggressive, surgical solution that resulted in autologous vascular access with a 6-month patency and also served to improve the quality of life in the seemingly hopeless case.
authors.affiliation: Department of Cardiovascular Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Bellows
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: Zulfiqar F
authors.initials: ZF
authors.lastname: Cheema
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006801:Humans; D007084:Iliac Vein / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008026:Ligation; D006435:Renal Dialysis; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*