Upper Extremity Ischemia/Dialysis Access

Vascular Access for Haemodialysis in Patients with Central Vein Thrombosis

Jakimowicz T, Galazka Z, Grochowiecki T, et al (Vascular and Transplant Surgery Med Univ of Warsaw, Poland) Eur J Vasc Endovasc Surg 42:842–849, 2011^§

Abstract

Objectives

Dialysis-dependent patients often have central venous drainage complications. In patients with functioning arm arteriovenous fistula, this may result in venous hypertension, arm oedema and vascular access failure. Percutaneous angioplasty and stent implantation might be inadequate to resolve these issues. In these cases, new access can potentially be created with anastomosis to the subclavian vein, iliac vein or vena cava or by making a veno-venous graft to bypass the thrombosis.

The aim of this study was to assess the utility of unusual bypasses in vascular access in patients with the central vein thrombosis.

Materials

A total of 49 patients were treated. The mean number of previous vascular access surgery procedures was 7.6 (3–17). We performed 19 axillo–iliac, 14 axillo–axillary bypasses and 16 conduits from the arm fistula to the jugular (nine conduits) or subclavian (seven conduits) vein for haemodialysis purposes.

Results

All fistulas except one were used for haemodialysis. One patient died before the first use of the fistula. At 12 months, the primary, primary assisted and secondary patency rates were 85.4%, 89.6% and 95.8%, respectively. The follow-up period ranged from 1 to 84 months.

Conclusion

Unusual grafts are an efficient option as a permanent vascular access for haemodialysis purposes in patients with central vein occlusion (Figs 3, 4 and 6).

Figure 3 PTFE bypass of the thrombosed proximal subclavian vein with spared native vessel fistula (9 patients). (Reprinted from European Journal of Vascular and Endovascular Surgery, Jakimowicz T, Galazka Z, Grochowiecki T, et al. Vascular access for haemodialysis in patients with central vein thrombosis. Eur J Vasc Endovasc Surg. 2011;42:842–849. Copyright 2011, with permission from the European Society for Vascular Surgery.)

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