EC Clinical and Medical Case Reports

Introduction: Central vein stenosis is a challenging problem faced by hemodialysis patients. Significant arm swelling, facial plethora, skin breakdown and loss of dialysis access are potential complications which limit both the quality of life and life expectancy of these patients. Amongst dialysis patients in Mombasa County, the incidence of subclavian catheter utilization is common, leading to a higher-than-expected incidence of symptomatic central vein stenosis.

Methodology: The goal of this paper is to describe the definitive surgical cure for a dialysis patient with symptomatic subclavian vein occlusion. Two methods are highlighted. Open bypass from the axillary vein to the superior vena cava using reversed deep femoral vein and bypass using a synthetic conduit. The cases are of particular value to low resource sites without access to complex endovascular treatment.

Results: Both cases presented demonstrated excellent recovery from the methods used. Neither patient had residual symptoms after the bypass graft. Furthermore, arteriovenous fistulas which could not be utilized for dialysis before the procedure could now be successfully used.

Conclusion: Open bypass using a reversed femoral vein bypass or a synthetic vessel graft as a conduit can successfully be used to manage patients with central vein stenosis.

Keywords: Central Vein Stenosis; Femoral Vein Conduit; Synthetic Graft

1. Gerald A Beathard., et al. “Central vein obstruction associated with upper extremity hemodialysis access”. UPTODATE (2021).
2. Korzets A., et al. “Subclavian vein stenosis, permanent cardiac pacemakers and the haemodialysed patient”. Nephron 1 (1991): 103.
3. Sticherling C., et al. “Prevalence of central venous occlusion in patients with chronic defibrillator leads”. American Heart Journal 5 (2001): 813-816.
4. Saad TF and Vesely TM. “Venous access for patients with chronic kidney disease”. Journal of Vascular and Interventional Radiology 10 (2004): 1041-1045.
5. Trerotola S., et al. “Treatment of subclavian venous stenoses by percutaneous transluminal angioplasty”. Journal of Vascular and Interventional Radiology 1 (1986): 15.
6. Beathard GA. “The treatment of vascular access graft dysfunction: a nephrologist's view and experience”. Advances in Renal Replacement Therapy 2 (1994): 131-147.
7. Selvanathan KS and Ariffin Azizi Z. “Extra-anatomical veno-venous surgical bypass for central vein occlusion in patients with ipsilateral arterio-venous fistula (AVF) for haemodialysis - A single center experience”. Medical Journal of Malaysia 1 (2017): 1-6.
8. Bouffard Y., et al. “Deep venous thrombosis with clinical signs after catheterization of the superior vena cava system”. Acta Anaesthesiologica Scandinavica Supplementum 81 (1985): 65-66.
9. Haage P., et al. “Treatment of Hemodialysis-related Central Venous Stenosis or Occlusion: Results of Primary Wallstent Placement and Follow-up in 50 Patients 1”. Radiology1 (1999): 175-180.
10. Dammers R., et al. “Central vein obstruction in hemodialysis patients: results of radiological and surgical intervention”. European Journal of Vascular and Endovascular Surgery 3 (2003): 317-321.
11. Anaya-Anaya J., et al. “Surgical Management of Hemodialysis-Related Central Venous Occlusive Disease: A Treatment Algorithm”. Annals of Vascular Surgery1 (2011): 117-129.