-Case Reports-

Venous Hypertension Improved by a Viabahn Stent Graft Blocking Regurgitation to the Periphery of the Basilic Vein in an Elderly Patient Undergoing Hemodialysis: A Case Report

Mitsutoshi Shindo^1,2, Sachiko Hirotani², Miho Tsukada¹ and Masamitsu Morishita^1,2

¹Department of Nephrology, Morishita Memorial Hospital, Kanagawa, Japan
²Department of Dialysis Vascular Surgery, Morishita Memorial Hospital, Kanagawa, Japan

Although necessary for hemodialysis (HD), arteriovenous grafts (AVG) frequently cause complications. Stenosis resulting in venous hypertension is a concern for physicians. Herein, we describe how venous hypertension was improved by using a Viabahn stent graft in an elderly HD patient. An 86-year-old woman started maintenance HD with a left-arm AVG. Two years later, she was referred to our hospital for treatment of juxta-graft-venous junction (GVJ) stenosis. Because of recurrence of stenosis at the juxta-GVJ, she underwent four percutaneous transluminal angioplasty (PTA) procedures during a period of 9 months. One month after the most recent PTA, the patient had redness, swelling, and pain in her left forearm. Venous hypertension was diagnosed on the basis of angiography findings showing regurgitation to the periphery of the basilic vein and juxta-GVJ stenosis. The stenosed juxta-GVJ was adequately expanded with a 7-mm balloon, and a 7-mm stent graft was inserted into the stenosis site. After successful treatment, there was no regurgitation to the periphery of the basilic vein and no symptoms. This complication should be considered when an AVG is created, because cutting off peripheral veins might prevent venous hypertension. Clinicians should perform regular postoperative monitoring.

J Nippon Med Sch 2023; 90: 351-355

Keywords
venous hypertension, viabahn stent graft, elderly patient, percutaneous transluminal angioplasty, hemodialysis

Correspondence to
Mitsutoshi Shindo, MD, MPH, Department of Dialysis Vascular Surgery, Morishita Memorial Hospital, 4-2-18 Higashirinkan, Minami-ku, Sagamihara, Kanagawa 252-0311, Japan
mitsu_shin@hotmail.com

Received, March 5, 2022
Accepted, April 21, 2022