Esophageal varices as a rare complication of central venous dialysis tunneled cuffed catheter

Hsu, Yung-Hsuen; Yang, Min-Ta; Hsia, Ching-Chih; Tsai, Dai-Hua

doi:10.1053/j.ajkd.2003.10.026

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…If the obstruction is at or below the azygous vein, esophageal vein flow will be toward the portal system and inferior vena cava and varices may involve the entire thoracic esophagus. 5,8 Evaluation of computed tomography scans of patients with SVC obstruction have, however, revealed that most common drainage patterns were systemic-to-systemic collateral veins that drain into the inferior vena cava without traversing the portal system. 8 Downhill varices represent 0.4% to 10% of esophageal varices but less than 0.1% of patients present with hematemesis.…”

Section: Discussionmentioning

confidence: 99%

“…5,8 Evaluation of computed tomography scans of patients with SVC obstruction have, however, revealed that most common drainage patterns were systemic-to-systemic collateral veins that drain into the inferior vena cava without traversing the portal system. 8 Downhill varices represent 0.4% to 10% of esophageal varices but less than 0.1% of patients present with hematemesis. 3,9 The most common etiology of bleeding downhill varices is a complication related to a venous catheter (27%).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

et al. 2021

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The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

et al. 2021

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“…Rheumatoid and congenital heart diseases are listed as etiologic factors, too. Mediastinal tumors were described less; for example, bronchial-and thyroid carcinomas and large lymphomas in the mediastinum and metastases were possible reasons [ 8 , 11 , 12 , 15 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Are Downhill Varices an Overlooked Entity of Upper Gastrointestinal Bleedings?

Ayvaz

Rakici

Allescher

2018

Gastroenterology Research and Practice

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Aim Downhill varices are not so safe as thought and can lead to life-threating or mortal bleeding complication, even if rare. In order to draw attention to this topic, we analysed 129 patients. Materials and Methods We evaluated the electronic endoscopy data records of all patients undergoing upper gastrointestinal endoscopy over a nine-year period from January 2004 till December 2012, within a retrospective approach. The primary endpoints, incidence, causes, kind of resulting upper gastrointestinal bleeding, and the severity of the bleeding were evaluated. Secondary endpoints were the evaluation of the size of downhill varices and a comparison of the risk of bleeding between downhill varices and uphill varices. Results Downhill varices were identified, described, and/or documented in 129 patients of 25,680 upper gastrointestinal endoscopies. 26 patients had central venous catheter or port implantation, 22 patients had a history of an implantation of a cardiac pacemaker, 7 patients had severe pulmonary artery embolism, and 4 patients had severe chronic obstructive pulmonary disease. Two patients had mediastinal tumors, and one patient had a large retrosternal goiter as a possible cause of the vena cava syndrome. Altogether, 62 patients were related to a vena cava superior syndrome; 67 were not. Conclusions Downhill varices can be seen with an incidence of 0.5%. Therapeutic means are the banding therapy as a safe and effective option. Severe bleedings associated with downhill varices can be mortal. Severe forms of downhill varices should be examined in relation to the origin in order to start a specific therapy.

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“…In hemodialysis patients with functioning upper-limb access, more specific signs include ipsilateral vascular access malfunction: elevated venous pressure during hemodialysis sessions, prolonged bleeding from puncture sites, and repeated thromboses [31,32]. Dilatation of alternative drainage veins might produce more remote signs and symptoms, including esophageal varices and dysarthria [33,34]. In rare situations, when both the innominate and azygos veins are partially or completely occluded bilaterally, retrograde flow into the internal jugular vein, dural sinuses, and the contralateral collaterals develops, adversely affecting cerebral venous drainage.…”

Section: Discussionmentioning

confidence: 99%

Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

Cleper¹,

Goldenberg-Cohen²,

Kornreich³

et al. 2007

Pediatr Nephrol

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Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.

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Esophageal varices as a rare complication of central venous dialysis tunneled cuffed catheter

Cited by 7 publications

References 7 publications

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

Are Downhill Varices an Overlooked Entity of Upper Gastrointestinal Bleedings?

Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

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