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Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients.
J Vasc Interv Radiol 2019; 30(11):1779-1784JV

Abstract

PURPOSE

To report results of percutaneous costoclavicular bypass for symptomatic thoracic outlet or cephalic arch occlusion in patients with arteriovenous fistula.

MATERIALS AND METHODS

A retrospective review of percutaneous costoclavicular bypass patients between 2014 and 2018 was performed. Stent grafts were placed subcutaneously over the clavicle from the fistula outflow (axillary or cephalic vein) into a jugular vein or collateral. The procedures were performed in patients who had exhausted or were not candidates for balloon dilation or intravascular stent placement.

RESULTS

Technical success was 100% (9/9) with resolution of symptoms in all patients. Indications were arm swelling in 67% (6/9), fistula dysfunction in 22% (2/7), and 1 enlarging aneurysm. The fistula outflow was cephalic in 67% (6/9) and axillary in 33% (3/9). The return vessel was external jugular in 78% (7/9) and internal jugular in 22% (2/9). Two overlapping Viabahn stent grafts were used in 88% of cases (7/8) and 3 stent grafts in 1 case. In the initial case, 2 Gore hybrid grafts were used. Stent graft diameter ranged from 9 mm to 13 mm. Mean follow-up was 852 ± 339 days (range, 488-1483 days). At 12 months and 24 months, primary patency was 67% and 67%, and secondary patency was 89% and 78%, respectively. Complications included late thrombosis and secondary infection. There were no anastomotic leaks or seromas associated with extravascular stent grafts.

CONCLUSIONS

The percutaneous costoclavicular bypass is a feasible option for thoracic outlet and cephalic arch occlusion in symptomatic dialysis patients.

Authors+Show Affiliations

Richmond Vascular Center, 173 Wadsworth Drive, North Chesterfield, VA 23236. Electronic address: hull.jeffrey@gmail.com.Richmond Vascular Center, 173 Wadsworth Drive, North Chesterfield, VA 23236.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31279684

Citation

Hull, Jeffrey, and James Snyder. "Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients." Journal of Vascular and Interventional Radiology : JVIR, vol. 30, no. 11, 2019, pp. 1779-1784.
Hull J, Snyder J. Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients. J Vasc Interv Radiol. 2019;30(11):1779-1784.
Hull, J., & Snyder, J. (2019). Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients. Journal of Vascular and Interventional Radiology : JVIR, 30(11), pp. 1779-1784. doi:10.1016/j.jvir.2019.04.021.
Hull J, Snyder J. Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients. J Vasc Interv Radiol. 2019;30(11):1779-1784. PubMed PMID: 31279684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients. AU - Hull,Jeffrey, AU - Snyder,James, Y1 - 2019/07/03/ PY - 2019/02/14/received PY - 2019/04/09/revised PY - 2019/04/16/accepted PY - 2019/7/8/pubmed PY - 2019/7/8/medline PY - 2019/7/8/entrez SP - 1779 EP - 1784 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 30 IS - 11 N2 - PURPOSE: To report results of percutaneous costoclavicular bypass for symptomatic thoracic outlet or cephalic arch occlusion in patients with arteriovenous fistula. MATERIALS AND METHODS: A retrospective review of percutaneous costoclavicular bypass patients between 2014 and 2018 was performed. Stent grafts were placed subcutaneously over the clavicle from the fistula outflow (axillary or cephalic vein) into a jugular vein or collateral. The procedures were performed in patients who had exhausted or were not candidates for balloon dilation or intravascular stent placement. RESULTS: Technical success was 100% (9/9) with resolution of symptoms in all patients. Indications were arm swelling in 67% (6/9), fistula dysfunction in 22% (2/7), and 1 enlarging aneurysm. The fistula outflow was cephalic in 67% (6/9) and axillary in 33% (3/9). The return vessel was external jugular in 78% (7/9) and internal jugular in 22% (2/9). Two overlapping Viabahn stent grafts were used in 88% of cases (7/8) and 3 stent grafts in 1 case. In the initial case, 2 Gore hybrid grafts were used. Stent graft diameter ranged from 9 mm to 13 mm. Mean follow-up was 852 ± 339 days (range, 488-1483 days). At 12 months and 24 months, primary patency was 67% and 67%, and secondary patency was 89% and 78%, respectively. Complications included late thrombosis and secondary infection. There were no anastomotic leaks or seromas associated with extravascular stent grafts. CONCLUSIONS: The percutaneous costoclavicular bypass is a feasible option for thoracic outlet and cephalic arch occlusion in symptomatic dialysis patients. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/31279684/Percutaneous_Costoclavicular_Bypass_for_Thoracic_Outlet_Syndrome_and_Cephalic_Arch_Occlusion_in_Hemodialysis_Patients L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(19)30412-9 DB - PRIME DP - Unbound Medicine ER -