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

Background: 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. Case Presentation: 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. Discussion: 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. Conclusion: 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.