Hemodialysis-associated subclavian vein stenosis

Abstract

This study was undertaken to evaluate hemodialysis-associated subclavian vein stenosis (SVS) and to clarify treatment of this condition. Forty-seven patients underwent upper arm venography to evaluate fistula dysfunction. Subclavian vein stenosis was documented in 12. Eleven of 12 had elevated venous dialysis pressure (196 +/- 8.9 mm Hg), and six had arm edema. All 12 had previously undergone subclavian cannulation on the side of the fistula. Thirty-five patients showed no evidence of subclavian vein stenosis. Twelve of these 35 patients (mean venous dialysis pressure 113 +/- 2.3 mm Hg) had undergone previous subclavian cannulation on the side of the fistula. The mean age of the fistula at the time of venogram in patients with subclavian vein stenosis was 17.0 months versus 5.8 months in patients with ipsilateral subclavian cannulation without subclavian vein stenosis. Percutaneous transluminal angioplasty (PTA) was performed on 11 of 12 patients with SVS lowering venous dialysis pressure and restoring patency to the fistula in 100%. Lesions recurred in two of 11 patients and were successfully retreated with PTA. We conclude that SVS is a common dialysis problem that is amenable to treatment with PTA. Elevated venous dialysis pressures are a sensitive indicator of this condition.

Endovascular treatment of occlusive central venous disease: one center's experience

“…9,12 Venous phlebography with digital subtraction is still considered the gold standard. 13 However, angiotomography and magnetic resonance angiography could be alternatives to conventional angiography, although it should be stressed that patients with slower glomerular filtration rates are at risk of developing nephrogenic systemic fibrosis, caused by the gadolinium used in magnetic resonance angiography.…”

“…3,[5][6][7][8] Other than catheters, another common cause of this type of injury in central veins is the turbulent venous flow of high output arteriovenous fistulas, which also cause endothelial injury followed by an inflammatory process. 1,9 Central occlusive venous disease can be symptomatic or asymptomatic. Symptoms can very depending on progression and the anatomic position of the disease.…”

“…Symptoms can very depending on progression and the anatomic position of the disease. 2,9 Stenosis and occlusions in subclavian veins can cause venous hypertension in upper limbs, characterized by edema, cyanosis, varicose veins, hyperpigmentation and even ulcers (Figure 1). In more central sites, such as the brachiocephalic vein, they can also cause edema of face and chest and induce development of the superficial venous network in this area.…”

“…In more central sites, such as the brachiocephalic vein, they can also cause edema of face and chest and induce development of the superficial venous network in this area. [9][10][11] In patients on hemodialysis, output may be reduced and venous pressure increased, leading to inefficient dialysis. Patients who have venous compression by tumors will also present the signs and symptoms of their underlying disease, combined with those of venous hypertension just described.…”

Central Venous Catheters in Dialysis: The Good, the Bad and the Ugly

“…In one study, there was 40-50% incidence of CVS with use of subclavian catheters [23,24]. However, internal jugular (IJ) catheters are not benign and a high incidence of CVS is also noted with IJ vein catheters [25].…”