Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
Division of Vascular Surgery, Department of Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
Cardiovasc Intervent Radiol. 2020 Dec;43(12):1942-1945. doi: 10.1007/s00270-020-02615-1. Epub 2020 Aug 17.
A woman with an upper extremity brachioaxillary arteriovenous dialysis graft presented with a 9-month history of profound ipsilateral arm swelling and numbness secondary to chronic axillosubclavian vein occlusion. Previous endovascular and open venous recanalization attempts were unsuccessful. A totally percutaneous extra-anatomic venous bi-bypass was created to salvage the dialysis access circuit and reconstruct the deep venous system. Using overlapping Viabahn stent-grafts, two parallel bypasses were created from the arteriovenous graft and brachial vein, respectively, to the brachiocephalic vein. The hemodialysis graft regained function. Upper extremity symptoms resolved within 48 h. This is the first reported percutaneous double-barrel technique of extra-anatomic venous bypass creation for simultaneous management of a failed dialysis access and chronic venous occlusive disease.
一位女性患者上肢肱动脉-腋静脉动静脉透析移植物出现了 9 个月的同侧手臂肿胀和麻木的情况，这是由于慢性腋窝锁骨下静脉阻塞引起的。先前的血管内和开放静脉再通尝试均未成功。采用完全经皮的解剖外静脉双旁路技术来挽救透析通路并重建深静脉系统。使用重叠的 Viabahn 支架移植物，分别从动静脉移植物和肱静脉创建两条平行旁路，通向头臂静脉。血液透析移植物恢复功能。上肢症状在 48 小时内得到缓解。这是首例经皮双腔技术创建解剖外静脉旁路以同时处理失败的透析通路和慢性静脉阻塞性疾病的报道。
