Arteriovenous fistula in the presence of subclavian vein thrombosis: A serious complication

Kahn, Delawir; Pontin, A. R.; Jacobson, J. E.; Matley, Philip J.; Beningfield, Steve; Zyl-Smit, R. Van

doi:10.1002/bjs.1800770631

Cited by 14 publications

(10 citation statements)

References 7 publications

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“…Recognition and management was minimal and reports were uncommon. 2,5,20 The increase in the incidence of central venous obstruction is most probable the result of the frequent use of temporary percutaneous catheters in dialysis patients and physician awareness of the problem. In this respect, the American Dialysis Outcome and Quality Initiatives (DOQI) guidelines, first released in 1997 and updated in 2000, state that subclavian vein catheterization should be avoided for temporary access in all patients with chronic renal failure due to the risk of central venous stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Central venous obstruction is usually accompanied by few if any complications. However symptoms, manifested by severe arm swelling, pain, and venous ulcers as a result of central venous obstruction in patients with ipsilateral arteriovenous fistulas for hemodialysis, endangers the usefulness of the vascular access 1,2 and result in significant morbidity of the patient. Venous outflow obstructions are considered to be due to high flow states and occur at sites of turbulence.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Central vein obstruction in hemodialysis patients: Results of radiological and surgical intervention

Dammers¹,

Haan²,

Planken³

et al. 2003

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Central vein obstruction in hemodialysis patients: Results of radiological and surgical intervention

Dammers¹,

Haan²,

Planken³

et al. 2003

European Journal of Vascular and Endovascular Surgery

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“…This is the treatment of last resort to relieve the edema and pain, and results in abandonment of that extremity for future access. This can be done by manual compression, balloon occlusion, surgical ligation (3), or percutaneous embolization (85).…”

Section: Management Of Cvsmentioning

confidence: 99%

Central Vein Stenosis: A Nephrologist's Perspective

Agarwal

Patel

Haddad

2007

Seminars in Dialysis

228

194

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Central vein stenosis is commonly associated with placement of central venous catheters and devices. Central vein stenosis can jeopardize the future of arteriovenous fistula and arteriovenous graft in the ipsilateral extremity. Occurrence of central vein stenosis in association with indwelling intravascular devices including short-term, small-diameter catheters such as peripherally inserted central catheters, long-term hemodialysis catheters, as well as pacemaker wires, has been recognized for over two decades. Placement of multiple catheters, longer duration, location in subclavian vein, and placement on the left-hand side of neck seem to predispose to the development of central vein stenosis. Endothelial injury with subsequent changes in the vessel wall results in development of microthrombi, smooth muscle proliferation, and central vein stenosis. Central vein stenosis is often asymptomatic in nondialysis patients, but can result in edema of ipsilateral extremity and breast when challenged by increased flow from an arteriovenous fistula or arteriovenous graft. Bilateral central vein stenosis or superior vena cava stenosis can produce a clinical picture of superior vena cava syndrome, associated with engorgement of face and neck. Endovascular interventions are the mainstay of management of central vein stenosis. Percutaneous angioplasty and stent placement for elastic and recurring lesions can restore the functionality of the vascular access, at least temporarily. Frequent or multiple interventions are usually required. In recalcitrant cases, surgical bypass of the obstruction is an option. In resistant cases with severe symptoms, occlusion of the functioning vascular access will usually provide relief of symptoms. Further study of mechanisms of development of central vein stenosis and search for a targeted therapy is likely to lead to better ways of managing central vein stenosis. Prevention of central vein stenosis is the key to avoid access failure and other complications from central vein stenosis and relies upon avoidance of central vein stenosis placement and timely placement of arteriovenous fistula in prospective dialysis patient.

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“…1 to 5% of these patients may present with a clinical picture of venous hypertension with arm swelling, pain and functional impairment, requiring treatment therapy. 2) Usually, a simple fistula ligation resolves the symptoms, but it eliminates a valuable vascular access and prevents the creation of a new ipsilateral one. Percutaneous angioplasty (PTA) is often used to treat venous stenosis.…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

Acri

Carmignani

Vazzana

et al. 2013

ATCS

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Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain. We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension. In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.

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Arteriovenous fistula in the presence of subclavian vein thrombosis: A serious complication

Cited by 14 publications

References 7 publications

Central vein obstruction in hemodialysis patients: Results of radiological and surgical intervention

Central vein obstruction in hemodialysis patients: Results of radiological and surgical intervention

Central Vein Stenosis: A Nephrologist's Perspective

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

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