Cephalic to jugular vein bypass surgery of subclavian vein stenosis for arteriovenous fistula salvage in maintenance hemodialysis patients.

Abstract

Background: Ipsilateral subclavian vein stenosis in a well-functioning upper extremity arteriovenous fistula (AVF) is a significant factor contributing to AVF failure and sometimes swelling of ipsilateral upper extremity. Graft bypass surgery can alleviate outflow tract stenosis in upper extremity AVF, restore function, and efficiently relieve arm swelling. The present study aimed to evaluate patency and postoperative complications after cephalic to jugular graft bypass surgery in patients with upper extremity AVF failure or upper extremity swelling on the same side of the AVF resulting from ipsilateral subclavian vein stenosis.

Methods: Five patients with upper extremity AVF and ipsilateral subclavian vein stenosis undergoing maintenance hemodialysis were included. Three patients had AVF dysfunction, while two experienced swelling of the arm due to high venous pressure in the AVF. The surgical procedure involved creating a subcutaneous tunnel in the shoulder to connect a 6 mm polytetrafluorethylene (PTFE) graft, from either near the fistula site (n = 3) or at the mid-upper arm cephalic vein (n = 2), to the jugular vein.

Results: Graft bypass surgery was successful, and all patients were able to resume hemodialysis postoperatively. Upper extremity edema improved, without any postoperative wound infections, non-healing wounds, steal syndrome, or high-flow AVF leading to heart failure as a complication. Five to 19 months after surgery, the bypass grafts exhibited a primary patency rate of 100%, and vascular access fulfilled the requirements for hemodialysis.

Conclusions: Cephalic to jugular vein bypass surgery for upper extremity AVF with ipsilateral subclavian vein stenosis effectively preserved function of the original fistula, and was associated with few postoperative complications.