Salvage of a dialysis angioaccess by bypassing a central venous obstruction to the common femoral vein

We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.

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Management of Upper Extremity Central Venous Obstruction Using Interventional Radiology

Annals of Vascular Surgery ◽

10.1007/s100169900141 ◽

1998 ◽

Vol 12 (3) ◽

pp. 202-206 ◽

Cited By ~ 34

Author(s):

Peter G. Kalman ◽

Thomas F. Lindsay ◽

Kim Clarke ◽

Kenneth W. Sniderman ◽

Leslie Vanderburgh

Keyword(s):

Interventional Radiology ◽

Upper Extremity ◽

Venous Obstruction ◽

Central Venous ◽

Central Venous Obstruction

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Femorofemoral venous bypass graft for the treatment of venous occlusion of the common femoral vein in a nine year old boy

Cardiovascular Surgery ◽

10.1016/s0967-2109(02)00027-3 ◽

2002 ◽

Vol 10 (4) ◽

pp. 359-361 ◽

Cited By ~ 1

Author(s):

P Coughlin

Keyword(s):

Femoral Vein ◽

Bypass Graft ◽

Venous Occlusion ◽

Venous Bypass ◽

Common Femoral Vein ◽

The Common ◽

Venous Bypass Graft

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Hemodynamic significance of collateral blood flow in chronic venous obstruction

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515569433 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 27-34 ◽

Cited By ~ 10

Author(s):

RLM Kurstjens ◽

MAF de Wolf ◽

JHH van Laanen ◽

MW de Haan ◽

CHA Wittens ◽

...

Keyword(s):

Blood Flow ◽

Femoral Vein ◽

Iliac Vein ◽

Balloon Occlusion ◽

Collateral Blood Flow ◽

Venous Obstruction ◽

Common Femoral Vein ◽

Thrombotic Disease ◽

Need For Treatment ◽

The Common

Introduction Complaints related to the post-thrombotic syndrome do not always correlate well with the extent of post-thrombotic changes on diagnostic imaging. One explanation might be a difference in development of collateral blood flow. The aim of this study is to investigate the hemodynamic effect of collateralisation in deep venous obstruction. Methodology Resting intravenous pressure of the common femoral vein was measured bilaterally in the supine position of patients with unilateral iliofemoral post-thrombotic obstruction. In addition, pressure in control limbs was also measured in the common femoral vein after sudden balloon occlusion in the external iliac vein. Results Fourteen patients (median age 42 years, 12 female) were tested. In eleven limbs post-thrombotic disease extended below the femoral confluence. Median common femoral vein pressure was 17.0 mmHg in diseased limbs compared to 12.8 mmHg in controls (p = 0.001) and 23.5 mmHg in controls after sudden balloon occlusion (p = 0.009). Results remained significant after correcting for non-occlusive post-thrombotic disease. Conclusion This study shows that common femoral vein pressure is increased in post-thrombotic iliofemoral deep venous obstruction, though not as much as after sudden balloon occlusion. The latter difference could explain the importance of collateralisation in deep venous obstructive disease and the discrepancy between complaints and anatomical changes; notwithstanding, the presence of collaterals does not eliminate the need for treatment.

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Review and Case Studies of Midthigh Femoral Central Venous Catheter Placement

Journal of the Association for Vascular Access ◽

10.1016/j.java.2018.06.004 ◽

2018 ◽

Vol 23 (3) ◽

pp. 167-175 ◽

Cited By ~ 2

Author(s):

Matthew Ostroff ◽

Nancy Moureau ◽

Mourad Ismail

Keyword(s):

Central Venous Catheter ◽

Case Studies ◽

Upper Extremity ◽

Femoral Vein ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Common Femoral Vein ◽

Vein Catheter

Abstract Background: Bedside vascular access options have been limited to the short peripheral intravenous, midline catheter, peripherally inserted central catheter, and central venous catheter (CVC) insertion sites such as the jugular, subclavian, and femoral vein. Many patients with limited options for upper extremity, subclavicular, supraclavicular, and cervical limitations have traditionally received a femoral CVC in the inguinal region. This insertion site is considered a high risk for infection because of its location in the inguinal region and associated difficulties with maintaining the dressing integrity. An alternative location was selected for the insertion of a femoral vein central venous catheter in the midthigh to reduce the risk of infection. Methods: After a multiple-year implementation process, midthigh femoral (MTF) insertions were performed on a select group of patients. The case studies that are included in this report outline the indications, procedures, and other pertinent aspects of the MTF placement. Patients at this institution with contraindications to upper extremity and thoracic catheter insertion received a MTF vein CVC in place of a traditional common femoral vein catheter insertion in the inguinal area. All procedural consents include permission for photography of procedure sites. Results: All but a single patient completed their therapy without complication; 1 intentional dislodgement by a patient was recorded. There were no MTF catheter-related bloodstream infections and 2 confirmed central line associated bloodstream infections (n = 2 of 100) with the second noted as probable contaminated specimen. Outcomes reflected no procedural complications (eg, expanding hematoma or femoral nerve injury or any other femoral artery or vein injuries) and 1 nonocclusive deep vein thrombosis (n = 1 of 100). Conclusions: The MTF CVC provides an alternative to traditional common femoral vein catheter placement for nonemergent patients with upper extremity and thoracic contraindications to central line placement.

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Hemodynamic changes in iliofemoral disease

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529206 ◽

2014 ◽

Vol 29 (1_suppl) ◽

pp. 90-96 ◽

Cited By ~ 5

Author(s):

RLM Kurstjens ◽

MAF de Wolf ◽

R de Graaf ◽

CHA Wittens

Keyword(s):

Femoral Vein ◽

Pressure Measurements ◽

Venous Obstruction ◽

Common Femoral Vein ◽

Thrombotic Disease ◽

Preliminary Results ◽

Need For Treatment ◽

Side Pressure ◽

Control Limb ◽

The Common

Background Iliofemoral venous obstruction, caused by post-thrombotic disease, can be treated by percutaneous angioplasty and additional stenting with good results. However, no hemodynamic parameter determining the need for treatment has been defined. This article describes the preliminary results of a study investigating the pressure changes occurring in post-thrombotic deep venous obstruction. Methodology Four patients with post-thrombotic deep venous obstruction of the iliofemoral tract were identified. Intravenous pressure was pre-operatively measured in the common femoral vein and in a dorsal foot vein bilaterally. During these pressure measurements patients were asked to walk on a treadmill with a speed of 3.2 km/h and a zero per cent slope, with the slope increasing two per cent every two minutes. Results Four patients (two male, two female) with age varying from 23 to 40 were identified. In two patients, disease extended below the femoral confluence. Pressure in the dorsal foot vein was not notably different between the affected and the control side. Pressure in the common femoral vein was markedly higher in post-thrombotic limbs compared to the control limb, with ambulatory pressure increasing more in post-thrombotic limbs. Conclusions These preliminary results are highly illustrative for the hemodynamic effect of iliofemoral deep venous obstruction due to post-thrombotic disease, even though sample size is admittedly limited. Furthermore, these results suggest that pressure measurements of the common femoral vein, and not the dorsal foot vein, might be able to identify a significant outflow obstruction due to post-thrombotic disease, though further inclusion of patients is necessary.

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When the common femoral vein is revealed as flattened on spectral Doppler sonography: is it a reliable sign for diagnosis of proximal venous obstruction?

American Journal of Roentgenology ◽

10.2214/ajr.168.3.9057525 ◽

1997 ◽

Vol 168 (3) ◽

pp. 733-736 ◽

Cited By ~ 21

Author(s):

A M Bach ◽

L E Hann

Keyword(s):

Doppler Sonography ◽

Femoral Vein ◽

Venous Obstruction ◽

Common Femoral Vein ◽

Spectral Doppler ◽

The Common ◽

Reliable Sign

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P1359PATTERNS OF CENTRAL VENOUS OBSTRUCTION AND OUTCOMES OF ENDOVASCULAR INTERVENTIONS IN CKD PATIENTS ON HAEMODIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1359 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Rajendra Mathur ◽

Dibyajyoti Kalita ◽

Amar Mukund

Keyword(s):

Femoral Vein ◽

Electronic Record ◽

Transluminal Angioplasty ◽

Maintenance Hemodialysis ◽

Venous Obstruction ◽

Central Venous ◽

Record System ◽

Endovascular Interventions ◽

Thrombosed Type ◽

Central Venous Obstruction

Abstract Background and Aims Central Venous Obstruction (CVO) is one of the major causes of morbidity in Chronic Kidney Disease (CKD) patients on maintenance Hemodialysis (HD). The aim of the study was to assess the patterns of CVO and the role of Endovascular interventions to restore the patency of vascular access in patients on HD with CVO. Method We report 15 cases of CVO in HD patients between April 2015 to April 2018. Data regarding patients’ basic information, primary disease, dialysis duration, access at initiation, number and sites of central venous catheterizations, vascular segments stenosed or thrombosed, type of endovascular interventions done and outcomes were collected from electronic record system. Results Out of 15 cases of CVO, 11 had the first dialysis with a temporary catheter either to Internal Jugular vein or femoral vein. The average time of presentation to our hospital from initiation of dialysis was 14.8 months. 8 patients presented with symptomatic SVC obstruction. The most common site of CVO was left Brachio-cephalic vein followed by right brachio-cephalic, right subclavian and left subclavian vein. 12 patients underwent Percutaneous Transluminal Angioplasty (PTA) and 3 required bare metal stenting (BMS) along with PTA. One patient required repeat PTA after 4 months. 11 patients did not require further procedure in the mean follow up period of 110 days. PTA was found to be successful in 11 out of 12 cases. Post PTA 9 patients underwent tunneled HD catheter insertion. Conclusion Patients of CKD who present late to the nephrologists require HD to be initiated through temporary catheters to central veins. Repeated central venous catheterization is associated with CVO. Endovascular intervention is an effective modality for maintaining HD access patency in such cases.

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Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

European Journal of Radiology ◽

10.1016/s0720-048x(02)00370-4 ◽

2004 ◽

Vol 49 (1) ◽

pp. 81-85 ◽

Cited By ~ 73

Author(s):

Cüneyt Aytekin ◽

Fatih Boyvat ◽

Mahmut Can Yağmurdur ◽

Gökhan Moray ◽

Mehmet Haberal

Keyword(s):

Upper Extremity ◽

Stent Placement ◽

Hemodialysis Patients ◽

Endovascular Stent ◽

Venous Obstruction ◽

Central Venous ◽

Endovascular Stent Placement ◽

Central Venous Obstruction

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Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.013 ◽

2014 ◽

Vol 13 (1) ◽

pp. 63-66 ◽

Cited By ~ 1

Author(s):

Felipe Jose Skupien ◽

Ricardo Zanetti Gomes ◽

Emerson Hideyoshi Shimada ◽

Rafael Inacio Brandao ◽

Suellen Vienscoski Skupien

Keyword(s):

Jugular Vein ◽

Venous Hypertension ◽

Cephalic Vein ◽

Cervical Region ◽

Axillary Vein ◽

Hemodialysis Access ◽

Venous Obstruction ◽

Central Venous ◽

The Right ◽

Central Venous Obstruction

It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL), few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

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