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

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.