Aggressive Costoclavicular Junction Decompression in Patients with Threatened AV Access

Annals of Vascular Surgery
Karl A IlligPeter R Nelson

Abstract

A substantial number of patients with threatened arteriovenous (AV) access are found to have stenoses at the costoclavicular junction (CCJ), which frequently are resistant to angioplasty and stenting. We believe that stenoses in this location will not resolve unless bony decompression is performed to relieve the extrinsic compression on the vein. This article describes our short- to medium-term results following such decompression in patients with failing fistulae. We reviewed a prospectively maintained database to identify all patients with threatened AV access operated on for stenoses at the CCJ. Pre- and postoperative course along with long-term follow-up were analyzed. Between July 2012 and December 2013, 24 patients with threatened access were operated on for CCJ stenoses at our institution. Fifteen had highly dysfunctional AV fistulae otherwise felt to need ligation, 10 had significant arm and/or head swelling, and 3 required access but had no contralateral options. In 6 patients, the subclavian vein was occluded and 18 stenotic; 5 of these had stents in place through the CCJ. Decompression was performed via claviculectomy in 3 patients, 2 of whom underwent reconstruction (one jugular vein, one prosthetic bypass) and 1 wa...Continue Reading

References

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Jun 26, 2003·The Annals of Thoracic Surgery·Harold C Urschel, Amit N Patel
Jan 24, 2009·The Annals of Thoracic Surgery·J Ernesto MolinaCharles A Dietz
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Jul 19, 2013·Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deut·E Atasoy

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Citations

Aug 18, 2016·Annals of Vascular Surgery·Veer ChahwalaHandel R Robinson
Apr 7, 2017·Seminars in Dialysis·Gerald A Beathard
Feb 7, 2017·The Journal of Vascular Access·Jurabek BabadjanovLee Kirksey
Jul 15, 2017·Cardiovascular Engineering and Technology·Eoin A MurphyJohn Graeme Houston
Aug 19, 2020·Cardiovascular and Interventional Radiology·Andrew WoernerJeffrey Forris Beecham Chick
Mar 7, 2021·Journal of Vascular Surgery. Venous and Lymphatic Disorders·Sungho LimDavid M Hardy

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