[Vascular access for hemodialysis in patients with central vein stenosis or obstruction]

The aim of our study was to report our experience with complex haemodialysis access procedures for patients presenting central vein stenosis or obstruction. Between September 2002 and December 2003 we performed 12 procedures on 10 patients presenting central vein stenosis or obstruction; all of them presented contraindications to peritoneal dialysis. Saphenous veins were used 6 times, twice as loops to the femoral artery and 4 times as transpositions to the popliteal artery above the knee; 3 axillary artery to popliteal vein PTFE bypasses; and 1 brachial artery to internal jugular vein PTFE graft. The PTFE graft to the jugular vein has been patent and regularly needled with a follow-up of 4 months. Four saphenous vein fistulae were regularly used for dialysis; 2 were never needled. Five saphenous fistulae clotted after an average life span of 4 months (range: 3 weeks-9 months) and one is still patent and in use (5 months). Both femoral vein transpositions have been patent and have been needled 3 times a week with a follow-up of 10 and 4 months; one had to be revised surgically after 9 months. Of the 3 axillary artery to popliteal vein grafts, one had to be closed after a week because of severe steal syndrome and 2 have been patent (1 year and 8 month follow-up) and have been needled regularly ever since. Seventy percent of these patients has been dialysed line free through their fistula despite severe central vein stenosis or obstruction. Although the follow-up needs to be longer we discuss the surgical, radiological and dialysis features of these patients and propose management guidelines for cases of central vein stenosis or occlusion.