Management of superior vena cava syndrome in a patient with a persistent left-sided superior vena cava

Presented is a case of superior vena cava (SVC) syndrome in a patient with a persistent left SVC with absent right-sided SVC. This patient's symptoms started after creation of a right-sided radiocephalic arteriovenous fistula for hemodialysis access and progressed to include severe right upper extremity and neck swelling with pain. Endovascular intervention was not feasible, and a right axillary to right femoral vein bypass using polytetrafluoroethylene was performed with successful alleviation of his symptoms. This highlights the presentation and management of SVC syndrome in a patient with aberrant central venous anatomy, while maintaining hemodialysis access.