Abstract:Background and Aims Central venous stenosis (CVS) is an important cause of hemodialysis access dysfunction. For patients with complex CVS who have failed conservative or endovascular treatment, or whose lesion anatomy is unsuitable for further endovascular intervention, relief of venous hypertension while preserving the existing dialysis access remains challenging. This study aimed to evaluate the safety, effectiveness, and midterm patency of extra-anatomic venous bypass using prosthetic grafts with the internal jugular vein as the outflow tract for hemodialysis-related symptomatic CVS.Methods The clinical data of 25 patients with hemodialysis-related symptomatic CVS who underwent extra-anatomic venous bypass using prosthetic grafts at the Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, between December 2021 and January 2025 were retrospectively reviewed. All patients underwent computed tomography venography of the upper extremity and central venous system before surgery. The inflow and outflow vessels, as well as the bypass route, were individually selected according to the location and extent of the lesion and the venous outflow condition. Perioperative outcomes, symptom relief, complications, and graft patency were assessed. Primary and secondary patency rates were estimated using the Kaplan-Meier method.Results Technical success was achieved in all 25 patients. The procedures included cephalic vein-to-ipsilateral internal jugular vein bypass in 7 patients, cephalic vein-to-contralateral internal jugular vein bypass in 6 patients, axillary vein-to-contralateral internal jugular vein bypass in 6 patients, axillary vein-to-ipsilateral internal jugular vein bypass in 2 patients, bilateral internal jugular vein bypass in 3 patients, and arteriovenous graft-to-ipsilateral internal jugular vein bypass in 1 patient. Venous hypertension-related symptoms, including limb, facial, or chest wall swelling, improved markedly after surgery. The difference in forearm circumference between the affected and contralateral limbs and venous pressure during hemodialysis were both significantly reduced after surgery (both P<0.05). One patient developed acute left heart failure and 2 developed wound hematoma; all recovered after appropriate treatment. No perioperative death or graft-related infection occurred. The median follow-up duration was 22 months. During follow-up, 5 patients developed bypass graft occlusion. Anastomotic stenosis occurred in 3 patients and was successfully treated with percutaneous transluminal angioplasty combined with open thrombectomy. The 1-year primary and secondary patency rates were both 86%, while the corresponding 2-year rates were 64% and 74%, respectively.Conclusion Extra-anatomic venous bypass using prosthetic grafts with the internal jugular vein as the outflow tract is a safe and effective option for hemodialysis-related symptomatic CVS. This procedure may preserve the existing dialysis access and relieve venous hypertension in patients with failed conservative or endovascular treatment, or with anatomy unsuitable for further endovascular intervention. Individualized selection of the inflow and outflow vessels is essential for achieving favorable outcomes.