Decompression of the Occluded Subclavian Vein in the Patient With Ipsilateral Threatened Access by Transposition of the Internal Jugular Vein

Abstract

Thrombosis or stenosis of the subclavian vein is frequently caused by cannulation for dialysis or nutritional access. In a patient with an ipsilateral arteriovenous fistula, the resulting edema and venous congestion can interfere greatly with dialysis and can lead to limb threatening significant disability to the point of phlegmasia cerulea dolens. The author describes four patients who underwent a recently described procedure to decompress the venous system in the setting of subclavian obstruction. A description of the technique is included.