Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report

INTRODUCTION: Central venous Occlusion (CVO) is a serious complication that occurs mainly in patients with long term central venous catheters for dialysis. It remains a challenge in vascular surgery. CASE PRESENTATION: We report a case of a patient with end-stage kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava and underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. CLINICAL DISCUSSION: Central venous catheters remains the main cause of CVO in ESKD. Although the endovascular therapy is the main approach in the treatment of CVO, the surgical bypass to the RA is often the last resort to preserve vascular access in hemodialysis patients. The autologous vein and bovine arterial bypass remains better than PTFE grafts in terms of long term patency. CONCLUSION: fistulas as a first approach for dialysis access must be privileged at the expense of central catheters. However bypass to RA by mini thoracotomy incision remains as an excellent option for dialysis access in ESKD with CVO.