Arteriovenous access creation for hemodialysis patients with superior vena cava occlusion

The feasibility of creating arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO) is debated due to impaired blood return to the right atrium. However, collateral venous networks may offer an alternative solution, allowing for the creation of peripheral AV access. This study evaluates the outcomes of AV access construction in hemodialysis patients with SVCO. A retrospective review of 18 patients with SVCO and patent azygous veins was conducted between August 2021 and June 2023. These patients underwent peripheral AV access creation, including fistulas and grafts. Collected data included baseline demographics, preoperative 3D CT reconstruction of thoracic vessels, central venography, vascular access types, surgical details, postoperative complications, and the timing and methods of interventions. AV access was successfully created in all patients, including 15 AV fistulas and 3 AV grafts. The average brachial blood flow rate before cannulation was 848.67 ± 132.03 mL/min. The median follow-up period was 18.5 months (range: 10-32 months). During follow-up, six patients required interventions, such as flow reduction or percutaneous transluminal angioplasty, to optimize blood flow or resolve venous obstruction. Two cases were classified as failed access at 10 and 18 months post-creation. One patient transitioned to peritoneal dialysis due to AVG dysfunction, while the other underwent bypass surgery for chylothorax. AV access can be successfully created and maintained in patients with SVCO and a patent azygous vein. Although mild venous obstruction symptoms may develop during follow-up, timely intervention can preserve access patency. For patients with limited vascular resources and challenging catheterization, this approach represents a viable option for establishing effective access.