Clinical Experiences with Axillo-Jugular Bypasses for Subclavian Vein Obstructions in Patients with Hemodiaysis

Song, Dan; Moon, Chul

Abstract

Insertion of a central venous catheter is the most common cause of subclavian vein obstruction. If there is a functioning arteriovenous fistula in the ipsilateral upper extremity, the venous hypertension symptoms of subclavian vein obstruction will be exacerbated. We performed the bypass reconstruction of subclavian vein obstruction with venous hypertension symptoms owing to a functioning arteriovenous fistula in the ipsilateral arm, and we reported on it here. From April 1995 to January 1997, eleven subclavian vein obstruction patients underwent axillojugular bypass operations to relieve their symptoms and to salvage the ipsilateral arteriovenous fistula. All the patients had intractable arm edema as a main symptom. The surgical procedures consisted of axillojugular transposition and artificial graft from the internal jugular vein to the axillary, cephalic and femoral veins. Eight patients (73%) had their a symptom relieves. These procedures salvaged vascular access and rapidly relieved the upper extremity swelling. We concluded that whenever possible, sites other than the subclavian vein should be used for temporary hemodialysis catheter placement and that the subclavian vein should be imaged before placement of a vascular-access graft in all patients who have a history of a prior or an indwelling subclavian catheter and that by using an axillojugular bypass, the access can be saved and the upper extremity swelling associated with the subclavian vein obstruction can be alleviate.