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Published on: April 27, 2019
Left axillary to right atrium anterior chest wall graft using bovine carotid artery conduit
Muhammad Mujeeb Zubair1, Matthew E Bennett1, Eric K Peden1
1Department of Vascular Surgery, DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX - USA.
Insights
Central venous occlusive disease in end-stage renal disease patients can compromise dialysis access. A novel chest wall graft using bovine carotid artery conduit offers a viable solution for life-threatening access loss.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Cardiology
Background:
- Central venous occlusive (CVO) disease affects superior vena cava (SVC) and inferior vena cava (IVC) in end-stage renal disease (ESRD) patients on dialysis.
- Dialysis access is critical for ESRD patient survival.
Observation:
- A patient with ESRD, SVC/IVC occlusion, and hypercoagulable state faced life-threatening dialysis access loss.
- A subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) was performed using a mini thoracotomy.
Findings:
- The case demonstrates a novel surgical approach for dialysis access creation.
- Utilized a bovine carotid artery conduit for a chest wall graft.
Implications:
- This technique offers a potential solution for ESRD patients with CVO and exhausted conventional access options.
- Highlights the adaptability of vascular grafts in complex dialysis access scenarios.
Introduction:
Central venous occlusive (CVO) disease involving the superior vena cava (SVC) and inferior vena cava (IVC) can occur frequently in patients with end-stage renal disease (ESRD) on chronic dialysis. Dialysis access is essential for the survival of these patients.
Case Description:
We report a case of a chest wall graft creation using bovine carotid artery conduit in a patient who was experiencing life-threatening loss of dialysis access secondary to her SVC and IVC occlusion along with a hypercoagulable state. We did a subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) using a mini thoracotomy incision.
Conclusions:
ESRD patients with CVO pose a unique challenge. We believe our approach can provide an excellent option for dialysis access in patients with exhausted conventional access options.
