Percutaneous Extra-Anatomic Double-Barrel Bypass for Salvage of Hemodialysis Access and Treatment of Venous Occlusive Di
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CASE REPORT
VENOUS INTERVENTIONS
Percutaneous Extra-Anatomic Double-Barrel Bypass for Salvage of Hemodialysis Access and Treatment of Venous Occlusive Disease Andrew Woerner1 • David S. Shin1 • Sandeep S. Vaidya1 • Sean T. Jones1 • Mark H. Meissner2 • Eric J. Monroe1 • Anthony N. Hage3 • Jeffrey Forris Beecham Chick1
Received: 16 April 2020 / Accepted: 2 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract A woman with an upper extremity brachioaxillary arteriovenous dialysis graft presented with a 9-month history of profound ipsilateral arm swelling and numbness secondary to chronic axillosubclavian vein occlusion. Previous endovascular and open venous recanalization attempts were unsuccessful. A totally percutaneous extraanatomic venous bi-bypass was created to salvage the dialysis access circuit and reconstruct the deep venous system. Using overlapping Viabahn stent-grafts, two parallel bypasses were created from the arteriovenous graft and brachial vein, respectively, to the brachiocephalic vein. The hemodialysis graft regained function. Upper extremity symptoms resolved within 48 h. This is the first reported percutaneous double-barrel technique of extra-anatomic venous bypass creation for simultaneous management of a failed dialysis access and chronic venous occlusive disease. Keywords Percutaneous extra-anatomic venous bypass Costoclavicular bypass Chronic venous occlusive disease Thoracic outlet syndrome Dialysis access End-stage renal disease Interventional radiology & Jeffrey Forris Beecham Chick [email protected] 1
Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
2
Division of Vascular Surgery, Department of Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
3
Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107, USA
Abbreviation AV Arteriovenous
Introduction Central venous occlusive disease is an adverse outcome in patients with upper extremity hemodialysis access. Occlusions, based on anatomic location, may be treated with recanalization and stent or stent-graft placement with 1-year primary and secondary patencies of 60% and 98%, respectively [1]. When endovascular treatments are unsuccessful, open surgical approaches may be beneficial. Surgical options for upper extremity central venous occlusions include claviculectomy, inflow banding to reduce flows and pressures while preserving hemodialysis access, and complex bypass graft reconstruction [2, 3]. Previous reports of surgical graft reconstruction have demonstrated 1-year primary and primary-assisted patencies of 40% and 85%, respectively [4, 5]. Given that hemodialysis patients are typically older with multiple comorbidities; however, open surgical approaches are not without risk [6]
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