Central, High Flow Subclavian Artery-Internal Jugular Vein Fistula for Venous Access

Abstract

A subclavian artery - internal jugular vein shunt was created for intermittent parenteral infusions in six patients who had undergone extensive intestinal resection because of Crohn's disease or ulcerative colitis. The flow rates through the shunt were initially around 1000 ml/min. In three patients the flow later increased, giving rise to mild cardiac symptomas. Slight disturbance from arm ischemia during work was experienced by two patients. Some patients were disturbed by murmurs from the shunt when the flow increased. Narrowing of the vein at the end-to-side anastomosis diminished excessive flow and relieved symptoms. There was no perioperative mortality, and no septic, hemorrhagic or wound healing complications occurred in connection with the six primary and nine secondary operations. The patency rate of fistula was 100% after one year, 83% after two years and 66% after three years. The shunt was well accepted by patients and by personnel. This type of A-V fistula for intermittent parenteral infusions seems to be a feasible alternative to other A-V shunts when the usual vascular access routes have been exhausted.