DFW Vascular

This is a case of a 55 y/o dialysis patient new to our practice who presented with a clotted dialysis access that was considered not treatable and received a femoral dialysis catheter for dialysis at an important medical center in Dallas. We were able to discover the culprit lesion, an occluded left thoracic vein stent (Brachiocephalic vein). We performed thrombolysis of the dialysis graft and recanalization/restenting of the thoracic vein stent restoring the function of the dialysis access. The procedure was performed at our endovascular angiosuite in Duncanville, Texas. The patient went home after the procedure.

This is a case of a 47 y/o on dialysis new to our practice, who has a left arm dialysis access severely dysfunctional causing severe left arm edema due to an occluded left thoracic (brachiocephalic vein) stent placed a few years ago. Previous attempts to open the central vein at other places had failed. We were able to recanalize the thoracic vein and restent it restoring its function. The procedure was performed at DFW Vascular outpatient angiosuite!

During the past two days we treated three dialysis patients with subclavian vein occlusion with endovascular recanalization and angioplasty at our office base endovascular suite. These lesions cause dialysis access dysfunction and upper arm swelling and threaten the function of the dialysis access with thrombosis.

This week has been about outpatient treatment of central vein stenosis in dialysis patients. It causes disabling arm edema and inadequate dialysis. These patients were treated at our office based outpatient endovascular suite under local anesthesia and sedation and were discharged to home the same day of the procedure!

First “inside-out” recanalization procedure with supraclavicular stentgraft to superior vena cava and right arm dialysis graft at Cayetano Heredia Hospital! Patient had occlusion of all main thoracic veins and had been on dialysis via a groin catheter!

Two recent cases treated by Dr. Pablo Uceda and Dr. Sam Ahn underscore the expertise of DFW Vascular surgeons in treating complex thoracic vein oclusion in dialysis patients. Their latest paper about this serious condition has recently been published online. https://pubmed.ncbi.nlm.nih.gov/37003464/

DFW surgeons Pablo V. Uceda and Sam S. Ahn latest paper about treatment of brachiocephalic vein occlusion in dialysis patients has been accepted for publication in the prestigious Journal of Vascular Surgery. This is the sixth paper published addressing the serious complication of central vein stenosis in dialysis patients since 2021 and illustrates the vast experience of DFW surgeons in the treatment of this condition.

We finished the year with 3 publications, and two more to come, to support our expertise in the treatment of complex venous occlusions to maintain the function of dialysis access in patients on hemodialysis! We are one of the few vascular groups in North Texas that provides complete care of patient's dialysis access: surgical creation of vascular access, evaluation and maintenance of function in our office based angiosuite, and open vascular and endovascular treatment of complex venous complications!

Two patients with failed left upper arm dialysis vascular access and axillary vein occlusion were catheter-dependent and were successfully treated using axillary vein stenting and new upper arm dialysis access placement. We successfully maintain dialysis access functioning in the non-dominant arm by "recycling" occluded veins instead of abandoning them.