血液透析患者の内シャント側鎖骨下静脈閉塞症に対する1手術治験例

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  • A CASE OF LEFT SUBCLAVIAN VEIN THROMBOSIS IN A HEMODIALYSIS PATIENT

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We experienced an operated case of subclavian vein thrombosis on the same side as an existing arteriovenous (AV) fistula in a hemodialysis patient who had no history of venous catheterization.<br> A 72-year-old woman placed on maintenace hemodialysis for diabetic nephritis presented with marked edema and swelling of her arm and shoulder about 10 months after establishment of a left AV fistula. Venography demonstrated total occlusion of the left subclavian vein accompanied by marked development of collateral circulation. The patient was diagnosed as having primary deep venous thrombosis of the left upper extremity after detection of complete obstruction of the left subclavian vein without predisposing catheter cannulation. Left axillary-internal juglar vein bypass was performed with a ringed E-PTEF graft.<br> In post-operative course, her symptoms disappeared completely for several months. Graft patency was confirmed by postoperative venography. The patient complained of the same symptoms 9 months after the bypass procedure. Venography showed the stenotic change (about 50% stenosis) of the anastomosis between the graft and internal juglar vein. Reconstruction against a stenotic anastomosis by dilatation with E-PTFE patch was done in combination with an operation of closure of AV fistula on the left arm. This procedure promptly relieved the swelling of her left arm and the superficial collateral veins disappeared gradually.<br> We should call attention to the disease as a possible shunt trouble for the hemodialysis patient.

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