Extra-anatomical Cephalic to Internal Jugular Vein Bypass for Central Venous Occlusion.

Extra-anatomical cephalic to internal jugular venovenous bypass is a surgical method of improving the patency of arteriovenous access in patients with central venous stenosis (CVS), which is infrequently performed. It can be more durable compared to percutaneous venoplasty for CVS. We present a 60-year male who developed right subclavian vein stenosis after brachiocephalic arteriovenous fistula. He had two sessions of venoplasty, but had recurrence. Later, his CVS lesion was not amenable to venoplasty. He underwent cephalic to internal jugular venovenous bypass with externally supported polytetrafluoroethylene (PTFE) graft. This provided immediate symptomatic relief and also salvaged his fistula, which was patent at his last follow-up visit at six months. Venovenous bypass can be considered earlier in 'selected' patients to deal CVS not amenable to percutaneous interventions.