Abstract

Background: Patency of the central veins is mandatory for proper function of hemodialysis fistula created at the upper extremities. Case Report: We present a case of dilatation of right brachiocephalic vein (RBCV) stenosis using a Wallstent implanted through the wall of another Wallstent, which had formerly been inserted into the left brachiocephalic vein and the superior vena cava (SVC). The left subclavian vein was subsequently permanently occluded which rendered the left upper extremity unsuitable for hemodialysis. PTA and implantation of a Wallstent extending from the RBCV to SVC through the wall of the initial stent proved very easy and apparently the only way to restore percutaneously normal flow and relieve congestion of the right arm. Conclusions: The optimal method of stent implantation into the large-size, branching vessels remains to be established. A comparative, observational study of various techniques may help to indicate the best approach to the problem.

Keywords: central venous occlusion, bifurcation, self-expandable stents, Angioplasty, chronic hemodialysis