Combined femoral vein transposition and iliac vein to suprarenal vena cava bypass as a last resort dialysis access.
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.
Bellows
Patricia H
PH
Department of Cardiovascular Surgery, The Methodist Hospital Research Institute, Houston, TX, USA.
Anaya-Ayala
Javier E
JE
Cheema
Zulfiqar F
ZF
Davies
Mark G
MG
Lumsden
Alan B
AB
Peden
Eric K
EK
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*