Novel Venovenous Bypass for Superior Vena Cava Syndrome - A Sequelae of Multitude Hemodialysis Access

A 44-year-old female presented with Stage 5 chronic kidney disease with complaints of bothersome left upper limb swelling and findings suggestive of superior thoracic syndrome. She was on maintenance hemodialysis through left brachiobasilic fistula and had a history of left subclavian vein stenting 8 months back. When percutaneous procedure was not possible, we resolved the obstruction with the left axillary vein to the left common femoral vein bypass with ringed expanded polytetrafluoroethylene graft under general anesthesia. She got relieved of her upper limb swelling and pain. Her AV Fistula was salvaged as well. This is not the first choice of intervention for central venous occlusive disease, but this may be an effective solution when the regular endovascular intervention is not possible.