Surgical Repair of Obstructed Hemodialysis Shunt Causing Venous Hypertension

Abstract

We report a case of obstructed hemodialysis shunt causing venous hypertension which could be treated by reconstruction of arteriovenous fistula using translocated peripheral cephalic vein. A 62-year-old woman on chronic hemodialysis was referred to our hospital complaining of right hand swelling with enlarged pulsatile veins of dorsum nanus. Ultrasonography revealed arterio-venous fistula was created by side-to-side anastomosis, and shunt vein was focally obstructed in just proximal of anastomotic site. Due to proximal obstruction of shunt vein, arterial blood flow turned to peripheral vein, which caused peripheral venous hypertension. Considering management of venous hypertension and reconstruction of hemodialysis shunt, we performed re-operation. Dilated distal cephalic vein was mobilized and cut for translocation. After translocation of this vein, end-to-end anastomosis to proximal intact shunt vein was performed. In this manner, we could treat venous hypertension without shortening of shunt vein.