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Venovenostomy for Outflow Venous Obstruction in Patients with Upper Extremity Autogenous Hemodialysis Arteriovenous Access

  • Clinical Research
  • Published:
Annals of Vascular Surgery

Abstract

Outflow venous obstruction is a common problem in patients with autogenous upper extremity hemodialysis access. Surgical revision to divert blood flow into the patent vein is sometimes possible to restore unobstructed flow. The result of this type of procedure is not yet well known. The purpose of this report is to describe our experience with outflow venovenostomy (VV) to salvage dysfunctional autogenous upper extremity arterial venous access (AVF) threatened by venous outflow obstruction in hemodialysis-dependent patients. All patients who underwent VV procedures between September 1999 and October 2004 were reviewed. Data regarding patient demographics, comorbidities, procedure indications, perioperative complications, as well as postoperative AVF function and patency were gathered from patient charts and dialysis records. A total of 11 patients underwent VV in the study period. The median age of the AVF prior to VV was 14 months, with a range of 4-45 months. Two patients had radial cephalic AVF, and they had VV done in the antecubital fossa. Nine patients had brachial cephalic AVF. Seven of them underwent cephalic vein transposition VV, while two patients had basilic vein transposition. Functional AVF was achieved after 1 month in 10 out of 11 patients. Five patients had no further access interventions, four patients required angioplasty at the VV site to maintain access function, and one patient had access infection requiring surgical revision during follow-up. One patient never achieved access function. Postintervention assisted functional patency was 90% ± 9.5% at 39 months. Median follow-up after VV was 16 months. Outflow VV is a viable surgical option for selected patients with failing AVF due to venous outflow obstruction.

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Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 910 West 10 Avenue, Vancouver, British Columbia, Canada, V5Z 4E3

    Jerry C. Chen MD, Dhafer M. Kamal MD & David C. Taylor MD

  2. Department of Medicine, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada

    Jacek Jastrzebski MD

Authors
  1. Jerry C. Chen MD
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  2. Dhafer M. Kamal MD
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  3. Jacek Jastrzebski MD
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  4. David C. Taylor MD
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Corresponding author

Correspondence to Jerry C. Chen MD.

Additional information

Presented at the Twenty-sixth Annual Meeting of the Canadian Society for Vascular Surgeons, Quebec City, Quebec, Canada, October 22, 2004.

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Chen, J.C., Kamal, D.M., Jastrzebski, J. et al. Venovenostomy for Outflow Venous Obstruction in Patients with Upper Extremity Autogenous Hemodialysis Arteriovenous Access. Ann Vasc Surg 19, 629–635 (2005). https://doi.org/10.1007/s10016-005-5413-z

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  • DOI: https://doi.org/10.1007/s10016-005-5413-z

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