Basilic Vein Thrombosis Near an Arterial-Venous Access Graft Resulting in a Symptomatic Upper Extremity

Abstract

Deep venous thrombosis of the upper extremity is a relatively uncommon condition that normally produces few if any symptoms. However, when this occurs in a patient with hemodialysis access in the same upper limb, significant sequelae may result. Although these may be remedied by the elimination of the arterial-venous loop, the critical importance of vascular access for most patients with end-stage renal disease and the difficulties associated with creating new access make it essential to preserve existing sites. Described is a patient with a left forearm access graft and symptoms in the same extremity arising from outflow occlusion proximal to the venous anasto mosis of the graft. An arteriogram was used to diagnose and locate the occluded area, revealing thrombosis of the basilic vein as the likely cause. This was then bypassed by using saphenous vein, thus salvaging the hemodialysis access. The patient did well postoperatively and was discharged without symptoms and with a functional arterial-venous loop.