Kilcoyne Maxwell F, Do-Nguyen Chi Chi, Moulick Achintya, Madan Nandini, Mahan Vicki, Conley Susan, Brady Paul S, Endean Eric D, Stevens Randy M
Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
J Card Surg. 2020 Sep;35(9):2370-2374. doi: 10.1111/jocs.14654. Epub 2020 Jul 11.
Left innominate vein occlusion is a known complication of pacemaker and central venous catheter placement. For dialysis-dependent patients with an arteriovenous fistula (AVF), this can prevent successful hemodialysis and may require surgical intervention.
An 8-month-old male was diagnosed with hemolytic uremic syndrome and became dialysis-dependent at 11 months of age. After multiple vascular access and peritoneal dialysis complications, the patient had construction of a brachiobasalic AVF in his left arm at 13 years old. While waiting for the AVF to mature, an attempt to remove a previously placed left subclavian vein port-a-cath was unsuccessful and a follow-up imaging revealed that the vessel had become occluded. The fistula remained patent, but due to arm swelling and venous obstruction, his fistula was not accessible. Multiple attempts to percutaneously cross the left innominate vein were unsuccessful and the patient was referred for surgical intervention. At 15 years old, the patient was taken to the operating room for transposition of the left internal jugular vein (LIJ) to the right internal jugular vein (RIJ). The LIJ was transected under the mandible and anastomosed to the RIJ. Subsequently the patient underwent VWING insertion rather than venous transposition for constant site dialysis. Although he has required frequent transcatheter dilation of the LIJ-RIJ anastomosis, the patient was successfully dialyzed using this fistula for 5 years. The patient received a cadaveric renal transplant at 5 years 20 days.
In cases of left innominate vein stenosis, transposing the LIJ can create a new left innominate vein that can alleviate venous hypertension and preserve fistula function. This procedure avoids sternotomy and only requires one anastomosis.
左无名静脉闭塞是起搏器置入和中心静脉导管置入已知的并发症。对于依赖动静脉内瘘（AVF）进行透析的患者，这可能会妨碍成功进行血液透析，可能需要手术干预。
一名8个月大的男性被诊断为溶血尿毒综合征，11个月大时开始依赖透析。在经历多次血管通路和腹膜透析并发症后，该患者13岁时在左臂建立了肱基底AVF。在等待AVF成熟期间，尝试移除先前置入的左锁骨下静脉输液港未成功，后续影像学检查显示该血管已闭塞。内瘘仍保持通畅，但由于手臂肿胀和静脉阻塞，无法使用该内瘘。多次经皮穿过左无名静脉的尝试均未成功，该患者被转诊接受手术干预。15岁时，患者被送往手术室，将左颈内静脉（LIJ）转位至右颈内静脉（RIJ）。LIJ在下颌骨下方切断并与RIJ吻合。随后，患者接受了VWING置入而非静脉转位，以便进行固定部位透析。尽管他需要频繁对LIJ-RIJ吻合口进行经导管扩张，但使用该内瘘成功进行透析达5年。患者在5岁20天时接受了尸体肾移植。
在左无名静脉狭窄的病例中，转位LIJ可形成一条新的左无名静脉，可缓解静脉高压并保留内瘘功能。该手术避免了胸骨切开术，仅需一次吻合。
