Left axillary to right atrium anterior chest wall graft using bovine carotid artery conduit

Abstract

Introduction:

Central venous occlusive (CVO) disease involving the superior vena cava (SVC) and inferior vena cava (IVC) can occur frequently in patients with end-stage renal disease (ESRD) on chronic dialysis. Dialysis access is essential for the survival of these patients.

Case description:

We report a case of a chest wall graft creation using bovine carotid artery conduit in a patient who was experiencing life-threatening loss of dialysis access secondary to her SVC and IVC occlusion along with a hypercoagulable state. We did a subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) using a mini thoracotomy incision.

Conclusions:

ESRD patients with CVO pose a unique challenge. We believe our approach can provide an excellent option for dialysis access in patients with exhausted conventional access options.

Keywords

Central venous occlusion Dialysis End-stage renal disease

Get full access to this article

View all access options for this article.

References

Kalra

Gloviczki

Andrews

. Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease. J Vasc Surg. 2003;38(2):215-223.

Jennings

Maliska

Blebea

Taubman

. Creating arteriovenous fistulas in patients with chronic central venous obstruction. J Vasc Access. 2016;17(3):239-242.

Niyyar

. Anterior chest wall arteriovenous grafts: an underutilized form of hemodialysis access. Semin Dial. 2008;21(6):578-580.

McGee

Gould

. Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123-1133.

Anaya-Ayala

Reardon

. Right brachial to atrial xenograft conduit for hemodialysis access: a case report. Ann Vasc Surg. 2015;29(8):1662.e13-e18.

Anaya-Ayala

Bellows

Ismail

. Surgical management of hemodialysis-related central venous occlusive disease: a treatment algorithm. Ann Vasc Surg. 2011;25(1):108-119.

Anaya-Ayala

Ismail

Reardon

. Endovascular salvage of a right brachial artery - right atrium hemodialysis graft using a covered endoprosthesis. J Vasc Access. 2012;13(4):520-523.

Babadjanov

Bernstein

Kirksey

. Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses. J Vasc Access. 2017;18(4):e39-e41.

Dixon

Beck

Vazquez

. DAC Study Group. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med. 2009;360(21):2191-2201.

10.

Morsy

Khan

Chemla

. Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: a prospective single-center experience. J Vasc Surg. 2008;48(5):1251-1254, 1254.e1.