Central venous obstruction and dialysis shunt

Centralvenous obstruction is a rare however typical lesion with patients on chronic hemodialysis. A still functional arteriovenous shunt in its run-in can cause serious disorder, especially painful congestion and an insuffici ent dialysis. Should the shunt be maintained, a run-off reconstruction is r equired. 13 patients were treated with a centralvenous obstruction combined with a complication of the shunt. In 8 patients the intervention was eithe r impossible from the beginning or finally proved to be not successful afte r repeated recanalisations. 6 out of these patients underwent a transsterna l reconstruction of their bypass (a total of 7 interventions). 2 patients d ied perioperatively, 2 patients died 1 year, respectively 1 1/2 years later with a still intact reconstruction, 2 patients are still alive. Their reco nstruction has been working for two, respectively three years. The bypass m aterial was large-calibrated e-PTFE with external support. Com pared to con ventional indications the catheter techniques proved to be less effective i n the treatment of central venous obstruction. One year after the first int ervention only three out of seven shunts could still be used for the dialys is. The longest symptom-foe period was 12 months. The operative reconstruct ion is indeed very effective but it implies considerable risks and effort. This method cannot be recommended to patients on chronic dialysis who are i n a poor condition.