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Updated: Oct 24, 2025
Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Left innominate vein stenosis treated with graft replacement with concomitant cardiac surgery
Kenichiro Takahashi1, Kazuto Chihara1, Yosuke Ishii1
1Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Insights
Left innominate vein stenosis, a cause of dialysis access failure, was successfully treated with graft replacement. This surgical approach, performed concurrently with aortic valve replacement, offers a promising alternative to angioplasty.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Nephrology
Background:
- Left innominate vein stenosis is a significant complication in hemodialysis patients.
- It leads to severe venous hypertension and vascular access failure.
- Current treatments like percutaneous transluminal angioplasty have shown unsatisfactory outcomes with low primary patency rates.
Observation:
- A 49-year-old male patient presented with symptomatic left innominate vein stenosis.
- The patient required concomitant aortic valve replacement surgery.
Findings:
- Successful treatment of symptomatic left innominate vein stenosis was achieved through graft replacement during aortic valve replacement via median sternotomy.
- The surgical intervention restored venous outflow and preserved vascular access.
Implications:
- Concomitant surgical repair of left innominate vein stenosis with aortic valve replacement presents a viable alternative to angioplasty.
- Careful management of cardiopulmonary bypass is crucial to prevent cerebral venous hypertension and potential irreversible brain damage during the procedure.
Abstract:
Left innominate vein stenosis is a serious complication that causes massive venous hypertension and vascular access failure in patients requiring hemodialysis. Percutaneous transluminal angioplasty has been the standard treatment strategy; however, the outcome has been unsatisfactory, with a low primary patency rate. We present the case of a 49-year-old man with symptomatic left innominate vein stenosis that was successfully treated with graft replacement concomitantly with aortic valve replacement via median sternotomy. During surgery, appropriate cardiopulmonary bypass circulation should be established to avoid cerebral venous hypertension, which can cause irreversible brain damage.
