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Brachial to internal jugular vein bypass. A case report
1Department of Surgery, St George Hospital (SGH), Beirut, Lebanon.
Insights
Percutaneous dialysis catheter placement can cause subclavian vein thrombosis. A brachial to internal jugular vein bypass successfully treated venous hypertension and preserved fistula function in a hemodialysis patient.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Percutaneous dialysis catheter placement in the subclavian vein is associated with a high incidence of axillary and subclavian vein occlusion.
- Hemodialysis is a crucial treatment for chronic renal failure, often requiring vascular access.
- Subclavian vein thrombosis can lead to significant upper extremity venous hypertension and complications.
Observation:
- A 62-year-old male patient on hemodialysis presented with recurrent thrombophlebitis in the right upper extremity.
- The patient had a history of chronic thoracic and abdominal aortic dissection and developed subclavian vein thrombosis post-catheter placement.
- The existing right radio-cephalic fistula was at risk of dysfunction due to venous hypertension.
Findings:
- A brachial to internal jugular vein bypass using a 6 mm polytetrafluoroethylene graft was surgically created.
- The bypass successfully alleviated symptoms of venous hypertension.
- The graft remained patent for 24 months post-surgery, preserving the radio-cephalic fistula's function.
Implications:
- Brachial to internal jugular vein bypass is a viable option for selected patients with subclavian venous lesions.
- This surgical technique can effectively manage venous hypertension and preserve hemodialysis access.
- Further studies support the use of this bypass when balloon angioplasty and thrombolytic therapy are not suitable.
Abstract:
The introduction of percutaneous dialysis catheter placement in the subclavian vein for temporary dialysis has contributed to the high incidence of occlusion of axillary and subclavian veins. We report the case of a 62-year-old male patient who had a history of a chronic dissection of the thoracic and abdominal aorta and who was on hemodialysis for chronic renal failure through a right radio-cephalic fistula. The patient complained of recurrent thrombophlebitis of the right upper extremity secondary to a subclavian vein thrombosis after catheter placement. A brachial to internal jugular vein bypass using ring 6 mm polytetrafluoroethylene graft was performed to alleviate the symptoms of venous hypertension and to preserve the function of the radio-cephalic fistula. This bypass is still patent 24 months after surgery. Many recent studies showed promising results with this bypass favouring its use in selected patients with subclavian venous lesions not amendable with balloon angioplasty and thrombolytic therapy.