Extra-anatomical veno-venous surgical bypass for central vein occlusion in patients with ipsilateral arterio-venous fistula (AVF) for haemodialysis - A single centre experience
- Author:
Saravana Kumar Selvanathan
;
Zainal Ariffin Azizi
- Publication Type:Journal Article
- Keywords:
Arteriovenous fistula;
extra-anatomical vein to vein bypass;
central vein occlusion;
central balloon venoplasty
- From:
The Medical Journal of Malaysia
2017;72(1):3-6
- CountryMalaysia
- Language:English
-
Abstract:
Objective: Central vein occlusion is a common complication
related to central vein catheter insertion for haemodialysis
which can be unmasked by an ipsilateral fistula creation,
leading to a dysfunctional arteriovenous fistula (AVF). We
describe an extra-anatomical venous bypass surgical
procedure performed to maintain vascular access and
reduce the symptoms of swelling of the ipsilateral upper
limb, neck and face.
Materials and Methods: We report 20 consecutive patients
with end-stage renal failure (ESRF) who had central vein
occlusion and were not amenable to endovascular
intervention. They underwent extra-anatomical vein to vein
surgical bypass. The axillary and iliac or femoral veins were
approached via infraclavicular and extraperitoneal groin
incisions respectively. In all the patients, an externally
supported 6 or 8 mm polytetrafluoroethylene (PTFE) graft
was used as a conduit and was tunnelled extra-anatomical.
All patients had double antiplatelet (Aspirin and Clopidogrel)
therapy post-operatively.
Results: Substantial improvement in the facial, neck and
upper limb swelling was noticed following this diversion
surgery. The vein to vein bypass was patent at 12 months in
10 out of 20 patients. Graft infection occurred in two (10%)
cases. Re-thrombectomy or assisted patency procedure
(stent/plasty) was done in four (20%) cases. The patients
with preoperative fistula flow rate of more than 1500 ml/min
and post-operative graft flow rate of more than a 1000 ml/min
were patent at 12 months (P=0.025 and p=0.034
respectively).
Conclusion. Axillary to iliac/femoral vein bypass can salvage
functioning ipsilateral fistula threatened by occluded upper
central vein and relieve their upper limb obstructive venous
symptoms.
- Full text:P020170303428495691603.pdf
