Abstract: Vascular access-related thoracic outlet syndrome (VA-TOS) is a rare complication in hemodialysis patients, which is closely associated with anatomical stenosis of the subclavian vein at the thoracic outlet, endothelial hyperplasia stimulated by the high blood flow of fistulas and central venous injury due to indwelling catheters. VA-TOS typically presents with progressive swelling and pain, cyanosis of the skin, upper limb superficial vein varicosity and dialysis dysfunction. The diagnosis mainly depends on imaging techniques such as ultrasound, computed tomography angiography, and digital subtraction angiography. Therapeutic strategies include endovascular interventions, surgical decompression, percutaneous costoclavicular bypass, hemodialysis reliable outflow graft, subclavian bypass, and flow reduction. This review summarizes the pathogenesis, clinical manifestations, diagnosis, and treatment of VA-TOS in hemodialysis patients.

Key words: font-family:Inter, -apple-system, BlinkMacSystemFont, ", font-size:16px, background-color:#F9FAFB, ">hemodialysis, vascular access-related thoracic outlet syndrome, endovascular interventions, surgical decompression, vascular bypass