Interventional management of a patient with multiple stenosis: subclavian, jugular and innominate trunk with arteriovenous fistula dysfunction

A case report.

Abstract

Introduction: Dysfunction of an arteriovenous fistula in the right upper extremity may be caused by subclavian vein injuries following catheter placement at the start of treatment, potentially leading to chronic stenosis sequelae that affect the development of the primary access.

Clinical case: This is a 66-year-old patient with stage 5d chronic kidney disease who is undergoing hemodialysis. He presented with a dysfunctional arteriovenous fistula and significant edema in the right upper extremity, along with collateral circulation.

Diagnostic workshop: Interventional treatment revealed chronic stenosis in the right subclavian vein and innominate trunk.

Outcome: Interventional treatment using a stent graft and balloon angioplasty significantly improved access flow, reduced edema, and enabled continued hemodialysis sessions without complications.

Conclusions: In interventional surgery, stent-grafts offer an effective solution to extend the useful life of vascular accesses, enhancing the quality of life and decreasing the need for repeated interventions in patients with exhausted accesses.