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Surgical bypass for subclavian vein occlusion in hemodialysis patients
Nicole M Chandler1, Bhargav M Mistry, Paul J Garvin
1Department of Surgery, St Louis University Health Sciences Center, MO, USA.
Insights
Surgical bypass effectively restores function in hemodialysis access sites blocked by subclavian vein issues. This procedure is crucial for patients with end-stage renal disease requiring long-term dialysis.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Devices
Background:
- End-stage renal disease (ESRD) patients rely heavily on hemodialysis.
- Subclavian vein stenosis or occlusion affects 20-50% of patients with central venous catheters.
- Surgical bypass is an established treatment for venous obstruction and dialysis access salvage.
Purpose of the Study:
- To evaluate the effectiveness of subclavian venous bypass procedures in salvaging hemodialysis access.
- To assess the long-term patency and functional outcomes of these bypasses.
Main Methods:
- Retrospective review of 12 subclavian venous bypass procedures (May 1987-May 2000).
- Patients underwent bilateral venograms prior to bypass surgery.
- Mean patient age was 55.5 years; 11 men and 1 woman.
Main Results:
- 100% of hemodialysis access sites remained functional at 1 month post-surgery.
- Patency rates at 1, 2, and 3 years were 80%, 60%, and 25%, respectively.
- One patient required graft thrombectomy at 14 months.
Conclusions:
- Subclavian venous bypass successfully relieves symptoms and salvages dialysis access in ESRD patients.
- Central venous system evaluation is vital for selecting appropriate bypass procedures.
Background:
The majority of patients with end-stage renal disease are dependent on hemodialysis. Significant stenosis or occlusion of the subclavian vein is known to occur in 20% to 50% of patients who have had central venous catheters inserted into the subclavian vein or the internal jugular vein. Surgical bypass of the obstructed venous segment proximal to a functioning dialysis access site is an established treatment to relieve symptoms and salvage the functional dialysis access.
Study Design:
A retrospective review of all subclavian venous bypass procedures performed at St Louis University Hospital from May 1987 to May 2000 was undertaken. Twelve procedures were performed during this time. The mean age of the patient was 55.5 years (range 17 to 72 years). There were 11 men and 1 woman. Before surgical bypass, all patients underwent bilateral venograms to evaluate their central venous systems.
Results:
An extraanatomic surgical bypass was performed in all patients. Patients were followed for a mean of 16 months (range 1 to 79 months). At 1 month, 100% of hemodialysis access sites remained functional. At 1 year, 80%; 2 years, 60%; and 3 years, 25% of the salvaged arteriovenous hemodialysis access sites provided for functional dialysis. One patient required thrombectomy of the bypass graft at 14 months.
Conclusions:
Surgical bypass of an occluded or stenotic subclavian vein segment is successful in providing both symptomatic relief and salvage of a functioning dialysis access in the hemodialysis patient population. Study of the central venous system is essential in selecting an appropriate bypass procedure in individual patients.