A clinical case of successful implantation of a avf prosthesis on the right shoulder of a patient with a central tunneling venous catheter installed in the corner (place) of the confluence of the transverse vein of the neck and the external jugular vein on the right

Patient A. with end-stage chronic renal failure secondary to urolithiasis and chronic tubulointerstitial nephritis has been undergoing programmed hemodialysis since 2021. Her medical history includes multiple surgeries for permanent vascular access: arteriovenous fistulas (AVF) in both upper limbs, arteriovenous grafts (AVG, synthetic prosthesis) in the left shoulder, and four tunnel central venous catheter (tCVC). She was admitted with AVF thrombosis on the left shoulder. Ultrasound examination revealed occlusions in both internal jugular veins, stenosis of the external jugular veins to 2 mm, and patients subclavian veins. A tCVC was implanted at the confluence of the transverse vein and the external jugular. The postoperative period was uneventful, and the catheter function was satisfactorily. After 14 days, an AVG was implanted in the right forearm with shoulder anastomoses, using a "forearm loop" configuration. In the postoperative period, an edema of the right upper limb appeared. After 21 days, the tCVC was removed, and fistulography revealed subocclusion of the right brachiocephalic trunk, with no stenosis or occlusion at the tCVC implantation site. Balloon angioplasty of the right brachiocephalic trunk was performed, resulting in regression of swelling in the right upper limb and chest. Over a 60 day follow-up period, the patient's condition remained, and hemodialysis was succesfuuly performed via the AVG.

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