Vascular Access for Haemodialysis in Patients with Central Vein Thrombosis

Abstract Objectives Dialysis-dependent patients often have central venous drainage complications. In patients with functioning arm arteriovenous fistula, this may result in venous hypertension, arm oedema and vascular access failure. Percutaneous angioplasty and stent implantation might be inadequat...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2011-12, Vol.42 (6), p.842-849
Main Authors: Jakimowicz, T, Galazka, Z, Grochowiecki, T, Nazarewski, S, Szmidt, J
Format: Article
Language:English
Subjects:
Adult
Aged
Anastomosis, Surgical - methods
Arteriovenous Shunt, Surgical - methods
Axillary Vein - surgery
Exotic fistula
Extra-anatomic fistula
Female
Haemodialysis
Humans
Iliac Vein - surgery
Jugular Veins - surgery
Male
Middle Aged
Renal Dialysis - methods
Reoperation
Subclavian Vein - surgery
Surgery
Upper Extremity Deep Vein Thrombosis - complications
Upper Extremity Deep Vein Thrombosis - surgery
Vascular access
Venous Cutdown - methods
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Summary:Abstract Objectives Dialysis-dependent patients often have central venous drainage complications. In patients with functioning arm arteriovenous fistula, this may result in venous hypertension, arm oedema and vascular access failure. Percutaneous angioplasty and stent implantation might be inadequate to resolve these issues. In these cases, new access can potentially be created with anastomosis to the subclavian vein, iliac vein or vena cava or by making a veno-venous graft to bypass the thrombosis. The aim of this study was to assess the utility of unusual bypasses in vascular access in patients with the central vein thrombosis. Materials A total of 49 patients were treated. The mean number of previous vascular access surgery procedures was 7.6 (3–17). We performed 19 axillo–iliac, 14 axillo–axillary bypasses and 16 conduits from the arm fistula to the jugular (nine conduits) or subclavian (seven conduits) vein for haemodialysis purposes. Results All fistulas except one were used for haemodialysis. One patient died before the first use of the fistula. At 12 months, the primary, primary assisted and secondary patency rates were 85.4%, 89.6% and 95.8%, respectively. The follow-up period ranged from 1 to 84 months. Conclusion Unusual grafts are an efficient option as a permanent vascular access for haemodialysis purposes in patients with central vein occlusion.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2011.07.022