Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses.
BACKGROUND
Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion.


METHODS
We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy.


RESULTS
Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access.


CONCLUSIONS
Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.
Vascular Surgery Department, Cleveland Clinic, Cleveland, OH - USA.
Jurabek
J
Babadjanov
Advanced Vein Treatment Center, North Las Vegas, NV - USA.
Rick
R
Bernstein
Vascular Surgery Department, Cleveland Clinic, Cleveland, OH - USA.
Lee
L
Kirksey
D000328:Adult; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D062905:Central Venous Catheters; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D010690:Phlebography; D006435:Renal Dialysis; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency