Bypass Graft to the Contralateral Internal Jugular Vein for Venous Outflow Obstruction of a Functioning Hemodialysis Access Fistula

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As survival among patients with renal failure improves, vascular access becomes more difficult, and preservation of functioning access increases in importance. Subclavian vein thrombosis associated with a distal arteriovenous fistula can result in massive and debilitating swelling of the affected extremity. We describe a novel crossover bypass grafting procedure to the contralateral internal jugular vein in a patient with a thrombosed internal jugular and subclavian vein. This procedure resulted in preservation of the functioning arteriovenous fistula and resolution of the symptoms. Unlike previously described crossover procedures to the contralateral basilic or axillary veins, this bypass graft has the added benefit of not obviating future fistula creation in that extremity.