Outcomes of Extra-Anatomic Surgical Bypass in Treatment of Central Venous Occlusive Disease in Pediatric Chronic Hemodialysis Patients: One-Year Follow-Up

Abstract Background Maintenance of hemodialysis vascular access patency in pediatric patients remains a key issue. Venous hypertension due to proximal central venous outflow obstruction is a major impediment to long-term arteriovenous access. Prior ipsilateral insertion of central venous catheters is a common risk factor. Management of Central venous occlusive disease (CVOD) in an attempt to avert sacrificing the fistula and improving symptoms of venous hypertension. Surgical bypass has the advantage of being a bale out technique for management of CVOD with maintaining the existing dialysis access and providing prolonged patency and satisfactory outcome specially with the scarce data about the role of endovascular intervention in management of CVOD in pediatric population. Objectives The aim of our prospective, observational study is to evaluate the efficacy and outcome of the surgical management of hemodialysis-related central venous occlusive disease in pediatric patients. Patients and Methods This study was conducted on (15) Pediatric patients with end stage renal disease on regular hemodialysis via upper extremity access who underwent extra-anatomic surgical bypass to treat symptomatic venous hypertension due to central venous occlusive disease. Bypass take-off was from subclavian vein, cephalic vein, or axillary vein of the affected side according to site of obstruction and outflow including contralateral subclavian vein, internal jugular vein or ipsilateral femoral vein. The study period started from June 2021 until May 2022. Patients included in the study were essentially attending the Vascular Outpatient Clinic at Ain Shams University Hospitals and Nasser Institute for Search & Treatment at Cairo. Results Regarding the type of bypass used in the studied patients, the most frequent type used is Lt Axillary to Rt Subclavian bypass and Lt Subclavian to Rt Subclavian bypass 3 (20%) followed by Rt Axillary to Lt Subclavian bypass, Rt Cephalic to Lt Subclavian bypass and Rt Axillary to Rt femoral bypass 2 (13.33%). Technical success was achieved in the 15 (100%) cases while functional success occurred in 13 (86.6%) cases; patients had performed their 4 hours hemodialysis sessions via their preexisting access within 24 h post-procedurally. No in-hospital morbidity or death was recorded. Primary patency rates at 1, 3, 6, and 12 months were 93.3, 86.6, 73.3, and 66.6%, respectively. Secondary patency rates at 1, 3, 6, and 12 months were 100, 93.3, 80, and 73.3%, respectively. Conclusion Extra-anatomic surgical bypass is safe and effective method for management of Central venous occlusive disease and has the advantage of being a bail out technique for maintaining the existing dialysis access and also providing symptomatic relief of venous hypertension, prolonged patency and satisfactory outcome.