Percutaneous Extraanatomic Bypass for Treatment of Central Venous Occlusions in Patients Undergoing Hemodialysis.

OBJECTIVE. The pipeline technique has been described for percutaneous creation of a long extraanatomic bypass for a thrombosed hemodialysis vascular access in patients with outflow veins that cannot be recanalized. However, when we used the pipeline technique in nonthrombotic vascular access sites to create a bypass to treat central venous occlusion, we encountered two technical challenges not mentioned in previous reports: bleeding from the peripheral incision and difficulty in pushing the stent-graft catheter through the subcutaneous track. CONCLUSION. We report our solutions for these two technical challenges and the treatment outcomes of percutaneous extraanatomic bypass for central venous occlusion in patients undergoing hemodialysis with access-related upper limb swelling.