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Vascular Surgery 2019 Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482 Page 35
March 28-29, 2019
Rome, Italy
Vascular Surgery
4th Edition of World Congress & Exhibition on
Stenosis of the brachiocephalic vein and percutaneous thoracic
thrombectomy with thrombectomy system– case report
E Swiecka, M Khaznadar, T Krönert and R Zippel
Elbe-Elster-Klinikum, Germany
E Swiecka et al., J Vasc Endovasc Therapy 2019, Volume 4
DOI: 10.21767/2573-4482-C1-005
Recurrent or long-term central catheterization could lead
to central thoracic venous stenosis or occlusion. The
symptoms are a shunt/fistula dysfunction or occlusion with
visible collateral circuit on the skin and increased venous
pressure during hemodialysis. A 78-year-old male with a
10-year history of hemodialysis contacted our service with
a dysfunction and aneurysm of the native brachiocephalic
fistula. Ultrasound and shuntography confirmed a partial-
thrombosed aneurysm and a small-caliber cephalic vein.
Both methods did not allow a clear statement on the central
venous outflow. During the first operation, the aneurysm
was resected, and the fistula vein repaired with a bovine
pericardial patch. Intraoperatively, the vein was visualized
and dilated in the proximal third and the result secured
with a covert stent. On the second postoperative day we
had to register a re-occlusion of the fistula and caused an
angio-CT of the thoracic veins, which showed a high grade
stenotic brachiocephalic vein and a moderate stenosis of
the subclavian vein. In a second procedure, partial resection
of the shunt vein with interposition of an alloplastic vascular
prosthesis and stenting of the brachiocephalic vein were
performed. On post op day 1, the reconstruction was
occluded again. The percutaneous thrombectomy was
performed from central to peripheral using a thrombectomy
system via shunt-prosthesis. This was followed by a stent
application from the brachial vein via the subclavian vein to
the already stented cephalic vein. A regular 8-week follow-
up showed regular shunt function, no re-occlusions and/
or need for further operations. In the case of recurrent
occlusion of dialysis shunts or fistulas, a central venous
drainage obstruction must always be ruled out. In a
simultaneous thrombosis of the vascular access, the use
of a thrombectomy system is effective and safe. Detected
stenoses of the central veins require stent restoration after
dilatation. Even with the use of relatively small-caliber
stents, we have seen no problems over an observation
period of two years.
Biography
E Swiecka graduated from the Medical University in Gdansk, Poland. In
2004 she moved to Germany in order to practice medical profession.
She conducted her residency (stage practice) in vascular surgery in Au-
gusta Hospital in Düsseldorf under supervision of prof. R. Kolvenbach
and in DRK- Hospital in Berlin under Dr. MNaundorf. Between July 2014
and July 2017 she held a post of the Consultant of Vascular Surgery at
theMedical University of Brandenburg in Neuruppin, Germany. InMarch
2018 she took a post of the Senior Consultant at the Vascular and En-
dovascular Surgery Department in Elbe-Elster Klinikum in Herzberg,
Germany. She is a Member of many national and international medical
societies, including European Society for Vascular Surgery, Polish Vas-
cular Surgeon Society and Bulgarian Society of Vascular Surgery. As for
hands-on clinical experience, she specializes in carotid and dialysis sur-
gery as well as endovascular procedures.