Central venous obstruction associated with a distal arteriovenous fistula can result in massive swelling of the affected extremity and venous hypertension. We present the surgical rescue of an axillary-axillary arterio-venous access ((necklace graft) between the left axillary artery to the contralateral axillary vein), compromised by central venous stenosis, by conversion into an arteriovenous axillary loop graft (AVALG) as an additional “exotic” grafting procedure in the anterior chest. This procedure resulted in the salvage of the patient's access and rapid resolution of the associated upper extremity swelling.
AyarragarayJ.E.Surgical treatment of hemodialysis-related central venous stenosis or occlusion: Another option to maintain vascular access. J Vasc Surg2003; 37: 1043–6.
2.
FulksK.D., HydeG.L.Jugular-axillary vein bypass for salvage of arteriovenous access. J Vasc Surg1989; 9: 169–71.
3.
MyersJ.L., MukherjeeD.Bypass graft to the contralateral internal jugular vein for venous outflow obstruction of a functioning hemodialysis access fistula. J Vasc Surg2000; 32: 818–20.
TeruyaT.H., Abou-ZamzamA.M.Jr., LimmW., WongL., WongL.Symptomatic subclavian vein stenosis and occlusion in hemodialysis patients with transvenous pacemakers. Ann Vasc Surg2003; 17: 526–9.
6.
YoussefJ.J., BrownC.D., FriedmanE.A.Asymmetric breast enlargement minus central venous thrombosis in a hemodialysis patient. Hemodial Int2008; 12: 30–3.
7.
ChemlaE.S., MorsyM., AndersonL., MakanjuolaD.Complex bypasses and fistulas for difficult hemodialysis access: a prospective, single-center experience. Semin Dial2006; 19: 246–50.
Jean-BaptisteE., Hassen-KhodjaR., HaudebourgP., DeclemyS., BattM., BouillanneP.J.Axillary loop grafts for hemodialysis access: midterm results from a single-center study. J Vasc Surg2008; 47: 138–43.
10.
ChuangF.R., HsiehM.J., LeeC.H.Axillary artery to contralateral axillary vein graft fistula in chronic hemodialysis patients. Ren Fail2003; 25: 871–8.
11.
CurrierC.B.Jr., WidderS., AliA., KuusistoE., SidawyA.Surgical management of subclavian and axillary vein thrombosis in patients with a functioning arteriovenous fistula. Surgery1986; 100: 25–8.
12.
MontagnacR., BourquelotP., SchillingerF.Arteriovenous fistula complicated by “fat arm” caused by proximal venous occlusion - salvage by axillo-jugular crossing bypass. Nephrologie1993; 14: 239–42.
HoballahJ.J., EidG.M., NazzalM.M., SharpW.J., CorsonJ.D.Contralateral internal jugular vein interposition for salvage of a functioning arteriovenous fistula. Ann Vasc Surg2000; 14: 679–82.
15.
SulimanA., GreenbergJ.I., AngleN.Surgical bypass of symptomatic central venous obstruction for arteriovenous fistula salvage in hemodialysis patients. Ann Vasc Surg2008; 22: 203–9.
16.
SandersR.J., CooperM.A.Surgical management of subclavian vein obstruction, including six cases of subclavian vein bypass. Surgery1995; 118: 856–63.
17.
SchulakJ.A., LukensM.L., MayesJ.T.Salvage of thrombosed forearm polytetrafluoroethylene vascular access grafts by reversal of flow direction and venous bypass grafting. Am J Surg1991; 161: 485–7.
18.
DubnerS., WeinbaumF.I.Salvage of upper arm access grafts by extension to the infraclavicular axillary vein. Am J Surg1987; 153: 407–8.
