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Operating management of central venous hypertension complicating upper extremity dialysis access

Petr Bachleda1, Petr Utikal, Lucie Kalinova

  • 12nd Clinic of Surgery, Teaching Hospital, Olomouc, Czech Republic. petr.bachleda@fnol.cz

Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
|September 17, 2008
PubMed

Insights

Surgical bypass effectively restores hemodialysis access in patients with central venous hypertension and arteriovenous fistula obstruction. This procedure offers a viable solution when endovascular options are unsuitable, ensuring continued dialysis function.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Central venous hypertension can compromise upper extremity arteriovenous (AV) fistula function for hemodialysis.
  • Axillosubclavian venous segment obstruction is a common cause of AV fistula failure.

Purpose of the Study:

  • To evaluate the efficacy of surgical bypass for salvaging functional AV fistulas in patients with central venous hypertension.
  • To assess the importance of bypass in cases of axillosubclavian venous segment obstruction.

Main Methods:

  • Retrospective analysis of 17 patients undergoing surgical bypass between AV fistula and internal jugular vein.
  • ePTFE grafts were used for bypass construction over a 20-year period (1987-2006).

Main Results:

  • The surgical bypass procedure had no intra- or post-operative complications.
  • Primary cumulative bypass and AV fistula function were maintained for an average of 26 months.

Conclusions:

  • Surgical bypass is a beneficial salvage option for functional dialysis access in central venous hypertension when endovascular treatment is not indicated.
  • Careful clinical and radiological assessment is crucial for selecting patients and monitoring bypass patency.
  • This intervention preserves essential hemodialysis access.
Abstract

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