Thrombosis or stenosis of the subclavian vein is frequently caused by cannulation for dialysis or nutritional access. In a patient with an ipsilateral arteriovenous fistula, the resulting edema and venous congestion can interfere greatly with dialysis and can lead to limb—threatening signifi cant disability to the point of phlegmasia cerulea dolens. Although balloon angioplasty and stenting are increasingly used to open subclavian stenoses and occlusions, surgical options may offer better initial and long-term results without the disadvantage of metallic stents across areas of potential future anastomoses. The indications for and techniques of jugular vein transposition are discussed in detail.
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