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Vascular. 13 May 2022: 17085381221092502. doi: 10.1177/17085381221092502. Online ahead of print.

ABSTRACT

BACKGROUND: In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central vein occlusions, along with their clinical presentation, surgical management, and a brief review of the literature.

METHODS: The first patient who was a 63-year-old woman with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functional right brachiocephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present to maintain temporary access to hemodialysis. The second patient was a 47-year-old man with a history of failed kidney transplant, coronary artery bypass graft, multiple AV fistula procedures in both extremities, leg amputation caused by peripheral arterial disease, and diminished function. myocardial. He was receiving 3/7 hemodialysis and was admitted to our clinic with edema of the right arm, accompanied by pain, stiffness and symptoms of cutaneous hyperpigmentation ipsilateral to a functional brachio-basilic AVF. He was unable to flex his arms, elbow or wrist due to severe edema.

RESULTS: Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After unsuccessful PT attempts, the patient was scheduled for axillary-axillary vein bypass to preserve AV access function. In the second patient, venography revealed occlusion of the right subclavian vein secondary to the subclavian venous catheters. Previous attempts at percutaneous crossing of the chronic subclavian lesion have repeatedly failed by different centers. Therefore, the patient was scheduled for an axillo-axillary vein bypass.

CONCLUSION: In chronic venous occlusions, endovascular procedures may be ineffective. Since preservation of vascular access function is crucial in this particular patient population, vein bypass procedures should be considered as an alternative to central venous reconstruction, before deciding on ligation and relocation of the FAV.

PMID:35549494 | DO I:10.1177/17085381221092502

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