Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008, 152(1):155-158 | DOI: 10.5507/bp.2008.025

OPERATING MANAGEMENT OF CENTRAL VENOUS HYPERTENSION COMPLICATING UPPER EXTREMITY DIALYSIS ACCESS

Petr Bachleda^a, Petr Utikal^a, Lucie Kalinova^a, Petr Drac^a, Josef Zadrazil^b, Martin Koecher^c, Marie Cerna^c

^a 2nd Clinic of Surgery, Teaching Hospital, Olomouc, Czech Republic

^b 3rd Clinic of Internal Medicine, Teaching Hospital, Olomouc

^c Department of Radiology, Teaching Hospital, Olomouc

Aim: To evaluate the importance of surgical bypass between the terminal part of functional arteriovenous shunt (av) for hemodialysis on upper extremity and inner jugular vein in axillosubclavian venous segment obstruction associated with central venous hypertension.

Method: Retrospective assessment of surgical bypass between central segments of av fistula and ipsilateral/contralateral inner jugular vein using ePTFE graft in 17 patients over a 20 year period (1987-2006).

Results: The surgical procedure was not associated with intra- or post-operative complications. Primary cumulative bypass and av fistula function persisted for 26 months on average.

Conclusion: An accurate bypass to salvage the functional dialysis access associated with central venous hypertension requires careful decision based on clinical and radiological examination. The bypass procedure is beneficial where endovascular treatment is not indicated. Clinical and radiological bypass monitoring is crucial.

Keywords: Hemodialysis arteriovenous fi stula, Central venous hypertension, Av fi stula – internal jugular vein bypass

Received: April 15, 2008; Accepted: May 10, 2008; Published: June 1, 2008  Show citation