Acri Ignazioe, Carmignani Amedeo, Vazzana Giovanni, Massara Mafalda, Acri Edvige, Lentini Salvatore, Spinelli Francesco
Cardiovascular and Thoracic Department, Policlinico G. Martino Hospital, University of Messina, Viale Gazzi, Messina, Italy.
Ann Thorac Cardiovasc Surg. 2013;19(1):55-9. doi: 10.5761/atcs.cr.11.01819. Epub 2012 May 15.
Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.
中心静脉血栓形成常发生于为临时血液透析通路进行中心静脉插管后。由于存在侧支循环，静脉血栓形成在临床上可能无症状。然而，如果在阻塞的静脉段下方准备动静脉（AV）内瘘，那么症状可能会出现。中心静脉高压会干扰透析，损害肢体功能并威胁其安全性。大多采用经皮治疗。然而，在某些情况下，血管内治疗可能并非易事，且长期通畅性不确定。我们报告了3例接受慢性血液透析治疗的患者的经验，这些患者存在通畅的AV内瘘和同侧锁骨下静脉慢性纤维化阻塞。他们接受了同侧颈内静脉至锁骨下静脉远端转位治疗。进行了两个单独的手术切口，以暴露锁骨下静脉阻塞远端以及远端结扎并转位的颈静脉。无死亡病例，术后也无明显并发症。所有患者在3 - 4周内高血压症状得到缓解。术后第一天起就使用AV内瘘进行透析治疗。随访（平均13个月）时，上肢静脉高压无复发。对于锁骨下静脉阻塞且同侧血流量低、AV内瘘通畅的患者，当经皮血管成形术在技术上不可行或预期长期通畅性不佳时，颈内静脉至锁骨下静脉远端转位可能是有用的。
