Central venous stenosis: What should a nephrologist know?

Mehta, Hemant

doi:10.4103/0971-4065.202825

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…Case reports and series to date have reported ipsilateral arm swelling and/or high venous pressures during dialysis as the most common features of symptomatic venous hypertension 2–4 9–15. Hemifacial swelling has also been reported 16. To our knowledge, this is the first case of tinnitus being present in this setting.…”

Section: Discussionmentioning

confidence: 70%

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

Steele¹,

Flowers

Coles

et al. 2019

BMJ Case Rep

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A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.

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Section: Discussionmentioning

confidence: 70%

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

Steele¹,

Flowers

Coles

et al. 2019

BMJ Case Rep

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“…In the patient with an AVF, the increase in size can reach aneurysmal proportions, resulting in so-called mega-fistula. 2, 9…”

Section: Discussionmentioning

confidence: 99%

“…It may be asymptomatic in nondialysis patients, and in patients on dialysis symptoms like edema of ipsilateral arm, neck, chest, and rarely aneurysmal dilatation of outflow veins when strained by high flow from an AVF or AV graft. 2 If stenosis progresses further, it might result in complete occlusion of central veins with multiple collateral formation, loss of access suitability for dialysis, and also further options of creating new vascular arteriovenous access on the affected limb is also lost.…”

Section: Introductionmentioning

confidence: 99%

“…Central venous stenosis is mainly due to the placement of central venous dialysis catheter which acts as a risk factor for development of thrombosis/vessel injury. 2, 3 Central venous system consists of draining veins to heart which are located above the diaphragmatic hiatus, below the thoracic outlet (intervertebral disc level C7-T1), and proximal to the lateral margin of the first rib. 4 Central vein obstruction in a dialysis patient has many undesirable effects, and it has a considerable impact on dialysis vascular access compared with obstruction of a peripheral vein.…”

Section: Introductionmentioning

confidence: 99%

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The Hulk Hand!—In a Hemodialysis Patient

Prabhakaran

Mahapatra

Singh

et al. 2021

Indian Journal of Clinical Medicine

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A 35-year-old gentleman who was on maintenance hemodialysis for last 20 months presented with progressive swelling of the left upper limb. Initially, he had right nontunneled internal jugular vein (IJV) catheter followed by left nontunneled IJV catheter through which he received dialysis for 2 months. Further, his left brachiocephalic fistula (BCF) was created 18 months back. Since then, he was on regular thrice weekly dialysis through BCF. He started developing swelling of the left upper limb 8 months after fistula creation, which was gradually increasing. Blood flow was found to be normal during dialysis, examination suggestive of entire left upper limb swelling with thick induration. Doppler showed dilated outflow veins with high flow without any narrowing/stenosis of veins. Computed tomography venography done showed left brachiocephalic vein stenosis. He was found to have mega-fistula secondary to central vein stenosis which was managed successfully being discussed in this case report. Undiagnosed occult central venous stenosis in the prearteriovenous fistula (AVF) construction can manifest in various ways; one of them is as mega-fistula. It is the generalized aneurysmal dilatation of the entire outflow vessels of an AVF. Management option for this condition is limited depending on the etiology, fistula flow has to be reduced either by banding of the vessel or by fistula closure. Assessment of central veins before AVF construction and regular access surveillance in dialysis patients may prevent complications like these.

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“…CVS can often be diagnosed by duplex ultrasound, with an absence of normal respiratory variation in the diameter of central veins and polyphasic atrial waves. It is difficult to visualize the central veins with duplex ultrasound in obese and muscular patients [9]. The author has seen patients with severe CVS presenting with not only ipsilateral limb edema but hemifacial swelling, diminished vision, and hearing loss on the right side and throbbing headache.…”

Section: Diagnosis Of Cvs In Symptomatic Patientsmentioning

confidence: 99%

Hemodialysis Vascular Access with Central Venous Disease

Mehta¹

2021

Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions

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Vascular access (VA) for hemodialysis (HD) is the lifeline of a patient. Arteriovenous fistula (AVF) is the gold standard of VA, but there are challenging situations when providing long-term VA becomes challenging, in the presence of central vein stenosis (CVS), which is common in patients on hemodialysis, but its exact prevalence is not known. It would be ideal to have proper venous mapping with imaging modality to be able to plan central venous access. This prior venous mapping will help to plan the target vein and delineate venous path to be able to place HD catheter in the best position or resolve the VA-related problems. However, digital subtraction angiography remains the gold standard of the procedure, during which the target vein is accessed via ultrasound guidance, and subsequent passage of wire is done under fluoroscopic guidance. Venous angiography and, if indicated, angioplasty are performed. For complete chronically occluded thrombotic veins, recanalization needs to be attempted. Stenting is reserved for a select group of patients. There are advances in endovascular techniques to deal with CVS, and it needs a multidisciplinary team approach to tackle the complex issues of VA-related central venous disease (CVD).

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Central venous stenosis: What should a nephrologist know?

Cited by 7 publications

References 11 publications

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

The Hulk Hand!—In a Hemodialysis Patient

Hemodialysis Vascular Access with Central Venous Disease

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