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

Background: For children with end-stage renal disease, maintaining the patency of the hemodialysis vascular access is
still crucial. Arteriovenous access is significantly hampered by venous hypertension caused by central venous occlusive
disease (CVOD). CVOD is managed with limited data regarding the role of endovascular intervention in pediatrics,
surgical bypass is a salvage technique for the dialysis access, resulting in prolonged patency and satisfactory outcomes.
Objectives: Our prospective, observational study is to assess the effectiveness and results of surgically treating juvenile
patients with CVOD associated with hemodialysis.
Patients and Methods: 15 pediatric patients with end-stage renal disease and CVOD receiving hemodialysis via upper
extremity access received extra-anatomic surgical bypass. The study started from June 2021 until May 2022. Patients
included in the study were attending the Vascular Outpatient Clinic at Ain Shams University Hospitals and Nasser Institute
at Cairo.
Results: Axillary to Rt Subclavian bypass 3 (20%) and Lt Subclavian to Rt Subclavian bypass 3 (20%) are the most
commonly used bypass configurations. Rt Axillary to Lt Subclavian bypass 2 (13.33%), Rt Cephalic to Lt Subclavian
bypass 2 (13.33%), and Rt Axillary to Rt femoral bypass 2 (13.33%). The other bypasses: Lt Cephalic to Rt Subclavian,
Rt Subclavian to Lt Subclavian and Lt Axillary to Lt Femoral are (6.66%). Within 48 hours, patients completed 4-hour
hemodialysis sessions using previous access; 15 instances (100%) had technical success, while 13 cases (86.6%) had
functional success. There were no documented in-hospital deaths or morbidities. At one, three, six, and twelve months, the
primary patency rates were 93.3, 86.6, 66.6, and 46.6%, respectively and the secondary patency rates were 100%, 93.3%,
73.3%, and 53.3%, respectively.
Conclusion: Extra-anatomic surgical bypass is an effective method for management of CVOD in hemodialysis pediatric
patients providing symptomatic relief of venous hypertension, prolonged patency, and satisfactory outcome.