Abstract
OBJECTIVE: Central venous stenosis (CVS) and cephalic arch stenosis (CAS) remain significant issues in the long-term management of hemodialysis access. Surgical bypass serves as a crucial option for symptom relief and access preservation when endovascular treatments fail. This study aimed to evaluate the effectiveness and safety of using the internal jugular vein (IJV) as the outflow tract in bypass surgery for CVS and CAS. METHODS: From December 2021 to September 2024, 21 patients undergoing hemodialysis who developed CVS (n = 15) or CAS (n = 6), were undertaken. Extra-anatomic venous bypass using the IJV were performed. Before surgical bypass, all patients had computed tomography angiography (CTA) and bilateral venograms of the upper central venous system. Color Doppler ultrasound was used to measure flow volume. A literature review was conducted to analyze the outcomes of previous studies that using venous bypass for the treatment of CVS in patients with upper extremity hemodialysis access. RESULTS: Technical success was achieved in all cases. Fifteen cases presented with CVS (11 men and 4 women, with a mean age of 56 ± 11 years [range, 37-82 years]) were treated by six surgical approaches include cephalic vein to contralateral-IJV bypass (n = 3), axillary vein to contralateral-IJV bypass (n = 5), external jugular vein to contralateral-IJV bypass (n = 2), IJV to contralateral-IJV bypass (n = 2), axillary vein to ipsilateral-IJV bypass (n = 1), cephalic vein to ipsilateral-IJV bypass (n = 1), and arteriovenous graft to ipsilateral-IJV bypass (n = 1). The median follow-up was 22 months (interquartile range, 12-24 months). The primary patency rate and secondary patency were 79% and 79% at 1 year and 65% and 79% at 2 years. Six patients presented with CAS (2 men and 4 women, with a mean age of 51 ± 9 years [range, 38 to 59 years]) and were treated by cephalic vein to ipsilateral-IJV bypass (n = 6). The median follow-up was 22 months (interquartile range, 15-26 months). The primary patency rate and secondary patency were 100% and 100% at 1 year and 60% and 60% at 2 years. All patients showed significant symptom improvement postoperation, with no perioperative mortality. CONCLUSIONS: Extra-anatomic venous bypass using the IJV as outflow tract is an effective and safe alternative, providing good graft patency and low postoperative complications during midterm follow-up. Careful selection of inflow and outflow tracts is crucial for optimal outcomes.