Factors Causing Loss of Normal Doppler Waveform of the Left Internal Jugular Vein: Evaluation on Chest Computed Tomography

Abstract

It is necessary to suspect steno-occlusive lesion of the LBCV from various causes and to use caution when performing central venous catheterization in cases with loss of a normal Doppler waveform.

Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping

“…There were no cases of central vein stenosis in this study in the absence of the risk factors we identified. This is in contrast to some studies that reported prevalence of central vein abnormalities ranging from 6% to 63% in patients without obvious risk factors for stenosis (7,(10)(11)(12)30). Although factors such as extrinsic compression or hemodynamic stress could contribute to central vein stenosis, our data suggest that their contribution to prevalence of central vein stenosis in the general population of patients with advanced CKD may be less important than previously reported.…”

“…Until additional data that clarify indications for implantable cardioverter defibrillators in the dialysis population are available, use of leadless pacemakers and defibrillators, or devices with epicardial rather than transvenous leads would be appropriate in those patients suitable for these kinds of devices (23,28). Central vein stenosis could occur in the absence of central vein instrumentation due to extrinsic compression by narrow thoracic inlet, dilated arteries, or benign or malignant growths in adjacent structures (7,20,21). In addition, reports of central vein abnormalities or stenosis in patients on hemodialysis without history of catheters have given rise to the hypothesis that high blood flow rates through fistulas or grafts could directly cause endothelial injury, which in turn leads to neointimal proliferation and stenosis (10,(29)(30)(31).…”

“…Which of these two imaging modalities produces superior dialysis access outcomes has not been studied, but its noninvasive nature, avoidance of radiocontrast, and ability to examine arterial anatomy have made Duplex ultrasound a preferred method of vascular mapping, except in patients with risk factors for central vein stenosis (2,5). The sensitivity and specificity of Duplex ultrasound for diagnosing central vein stenosis, however, are limited and venography remains the gold standard for evaluation of central vein patency (6,7).…”