Jugulo-Jugular PTFE Bypass for Central Venous Occlusion in a Hemodialysis Patient: A Case Report

Central venous stenosis (CVS) is a common complication in patients undergoing long-term hemodialysis, usually due to repeated central venous catheterizations. It frequently leads to venous hypertension, arteriovenous fistula (AVF) dysfunction, and morbidity. Endovascular interventions are first-line but often fail in chronic total occlusions. A 52-year-old male with chronic kidney disease on maintenance hemodialysis via a right brachiocephalic AV fistula presented with progressive swelling of the right face, neck, and upper limb, worsened post-dialysis. He reported difficulty with AV fistula cannulation. CT venography demonstrated complete right internal jugular vein (IJV) occlusion. Due to chronicity of the lesion and limited feasibility of endovascular options, a right-to-left IJV bypass using a polytetrafluoroethylene (PTFE) graft was performed. The bypass restored venous return, relieved symptoms, and preserved AV fistula function. Central venous occlusion is often refractory to venoplasty or stenting in chronic lesions. Surgical jugulo-jugular PTFE graft bypass offers a less invasive alternative to thoracic bypass and provides effective decompression of the venous system. Early outcomes demonstrate promising patency and symptom relief. Jugulo-jugular PTFE graft bypass is a practical surgical option for dialysis patients with central venous occlusion unresponsive to endovascular treatment. It relieves venous hypertension, preserves dialysis access, and avoids more invasive thoracic procedures.