Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

Abstract

Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain. We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension. In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.

Transposition of external jugular to proximal internal jugular vein for relief of venous thoracic outlet syndrome and maintenance of arteriovenous fistula access for chronic hemodialysis: A new approach

“…Patients reported resolution of their venous hypertensive symptoms within 3-4 weeks of their procedures and experienced no recurrence of symptoms at a mean follow-up length of 13 months. 13 Furthermore, Chandler and colleagues conducted a retrospective review of all SCV bypass procedures performed at their institution over a 13-year period for patients with venous hypertensive symptoms in the setting of an ipsilateral AVF. Of note, 11 of the 12 patients were male and eight of the patients underwent SCV to IJV bypasses, the majority of which had ipsilateral anastomoses created.…”

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

“…Extra-anatomical bypass like axillary-to-internal jugular vein is less distressing to the patient but this again results in the loss of another central vein for further access. 1, 2…”