title: Placement of Upper Extremity Arteriovenous Access in Patients with Central Venous Occlusions: A Novel Technique.
abstract: BACKGROUND
  Central venous occlusion is a common occurrence in patients with end-stage renal disease. Placement of upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins is often not an option. Avoidance of lower extremity vascular access can decrease morbidity and infection.
  
  
  METHODS
  The central venous lesions were crossed centrally via femoral access. The wire was retrieved in the neck extravascularly. A Hemodialysis Reliable Outflow catheter was then placed in the right atrium and completed with an arterial anastomosis.
  
  
  RESULTS
  We describe a novel technique for placing upper extremity arteriovenous access in patients with occlusion of the brachiocephalic veins. This technique was utilized in 3 patients. The technical success was 100%.
  
  
  CONCLUSIONS
  The placement of upper extremity arteriovenous access in patients with central venous occlusions is technically feasible.
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Allen G
authors.initials: AG
authors.lastname: Murga
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Chiriano
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Christian
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Neha
authors.initials: N
authors.lastname: Sheng
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Sheela
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Zamzam
authors.affiliation: Division of Vascular Surgery, Loma Linda University, Loma Linda, CA. Electronic address: tteruya@llu.edu.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Teruya
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011474:Prosthesis Design; D006435:Renal Dialysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014652:Vascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging