Management of Thoracic Outlet Syndrome in Patient with Hemodialysis Access

Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. Herein, we review the management of dialysis patients with central venous lesions at the thoracic outlet as well as the role of surgical decompression with first rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.