Brachial to internal jugular vein bypass. a case report

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 6mm 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