# Modified Subclavian Artery-to-Right Atrium Bypass Technique in a Patient on Chronic Hemodialysis With Central Venous Occlusion

## TL;DR

A modified surgical technique is described for creating a dialysis access in a patient with failed traditional sites and central venous occlusion.

## Contribution

A minimally invasive subclavian artery-to-right atrium bypass technique using PTFE is presented as a last-resort option.

## Key findings

- The technique was technically successful in creating a new dialysis graft.
- A right anterior mini-thoracotomy approach was used with a PTFE prosthesis.
- The method is suitable for patients with chronic central venous occlusion.

## Abstract

It is not uncommon for all of the usual upper and lower extremity autogenous access sites to fail, often in patients for whom neither peritoneal dialysis nor transplantation is an appropriate option or is difficult to access, and who have chronic central venous occlusion. Right atrium bypass may be used as a last resort. We describe our technique through this clinical report.

The patient is 40 years of age and has a history of type 1 diabetes. The bypass was performed via a minimally invasive approach (right anterior mini-thoracotomy), using a polytetrafluoroethylene (PTFE) prosthesis as a conduit; all procedures were technically successful and resulted in the creation of a new dialysis graft in the thorax.