Internal jugular vein bypass for central venous obstruction with associated visual impairment

Abstract

Central venous obstruction (CVO) is a common complication in hemodialysis (HD) patients that can lead to rare but potentially reversible visual impairment (VI). We report the case of a 50-year-old female with end-stage renal disease and uremic cardiomyopathy, who had received HD through a left radiocephalic arteriovenous fistula (AVF) for 6 years. She presented with progressive swelling in her left arm, chest wall, and face over the past year, along with vision loss and diplopia in the last 6 months. Angiography revealed occlusion of the left brachiocephalic vein. After unsuccessful percutaneous transluminal angioplasty attempts, she underwent a left-to-right internal jugular vein (IJV) bypass to maintain AVF function. The vascular graft was placed between the trachea and neck skin. Postoperatively, significant swelling reduction and partial vision restoration were noted. At a 2-year follow-up, the graft remained patent, allowing normal HD procedures. This surgical method may be a viable alternative after failed endovascular treatment for CVO, effectively preserving venous access, prolonging HD sustainability, and potentially reversing CVO-related VI.