Dialysis Access-Induced Superior Vena Cava Syndrome

Madan, Atul K.; Allmon, Jon Christian; Harding, Michael; Cheng, Swk; Slakey, Douglas P.

doi:10.1177/000313480206801016

Cited by 32 publications

(1 citation statement)

References 9 publications

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“…[15][16][17] In some cases, a silent central venous stenosis could become symptomatic if an AVF is created ipsilateral to the stenosis with a mechanism caused by the increased arterial inflow with an inadequate venous outflow. 18,19 As a less common cause, peripherally placed central venous catheters are found to be responsible for 7% of central vein occlusions or central venous stenosis in a venographic study. 20 Also, cardiac pacemakers and percutaneous defibrillators are associated with 50-64% of central venous stenosis detected with angiography.…”

Section: Discussionmentioning

confidence: 99%

A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature

Meriç

ÖZTAŞ

Çakir³

et al. 2022

Vascular

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Background In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. Methods The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. Results Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. Conclusion In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.

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