SURGICAL-MANAGEMENT OF BRACHIOAXILLARY-SUBCLAVIAN VEIN OCCLUSION

Objective: The possibility of using Ring PTFE graft as venous bypass t o preserve arteriovenous graft function and reduce upper extremity swe lling. Methods: Twenty-two patients with stenosis/occlusion of the bra nchial-axillary-subclavian vein segment in haemodialysis patients (n = 19) and patients with penetration injury (n = 3) who were not candida tes for balloon angioplasty were treated with ring PTFE venous bypass in renal patients and jugular to axillary vein transposition for traum a patients and followed for 10-87 months (mean 31) using venography, D oppler analysis and Duplex scanning. Results: There was no death or ne urologic deficit resulting from the venous bypass. Resolution of swell ing occurred in 8-48 h. 19/22 (86%) of the bypasses and 3/3 transposit ions remained patent after a mean follow-up of 31 months (10-87) month s. The attrition was due to AV graft occlusion (n = 2) and infection r equiring graft removal (n = 1). Conclusions: Ring PTFE graft is an acc eptable venous bypass for branchial-axillary-subclavian stenosis/occlu sion to reduce arm swelling and preserve the function of AV grafts in patients with lesions not amendable with balloon angioplasty or thromb olytic therapy. Jugular-axillary transposition is inappropriate for re nal patients.