[Anterior jugular-internal jugular bypass to salvage a dialysis arteriovenous fistula]

Thrombosis of the anonymous vein can compromise the arteriovenous fistula in chronic renal patients on hemodialysis. Clinical manifestations include edema of the arm, stasis acrocyanosis, tugor of the neck and shoulder veins, and severe headache. The fistula may have to be closed to achieve symptom relief, requiring a catheter for dialysis until an new arteriovenous fistula becomes functional. In case of stenosis or occlusion of the brachiocephalic venous axis, the goal is to preserve a functional fistula yet resolve symptoms. Self-expanding stents have been used but results have been less than satisfactory or short-lived. Different surgical bypass techniques have been proposed. We report an anterior jugular-internal jugular bypass used to salvage a dialysis arteriovenous fistula.