Percutaneous Extraanatomic Bypass for Treatment of Central Venous Occlusions in Patients Undergoing Hemodialysis.

Abstract

<b>OBJECTIVE.</b> The pipeline technique has been described for percutaneous creation of a long extraanatomic bypass for a thrombosed hemodialysis vascular access in patients with outflow veins that cannot be recanalized. However, when we used the pipeline technique in nonthrombotic vascular access sites to create a bypass to treat central venous occlusion, we encountered two technical challenges not mentioned in previous reports: bleeding from the peripheral incision and difficulty in pushing the stent-graft catheter through the subcutaneous track. <b>CONCLUSION.</b> We report our solutions for these two technical challenges and the treatment outcomes of percutaneous extraanatomic bypass for central venous occlusion in patients undergoing hemodialysis with access-related upper limb swelling.