Lifting the Veil

Bilateral Central Vein Stenosis: Options for Dialysis Access and Renal Replacement Therapy when all upper Extremity Access Possibilities have been Lost

“…However, many patients with bilateral central vein occlusion can be successfully managed with a relatively limited number of second-line access options. These treatment options include tunnelled catheters [femoral (9,10) and translumbar (11)], lower limb access [native long saphenous vein loop (12) or prosthetic (13)], peritoneal dialysis (14) and renal transplantation. The infection and occlusion rates of these second-line access procedures (particularly those in the lower limb) are recognized to be higher than autologous upper limb fistulae (15); however, they can provide effective access for haemodialysis, either in isolation or in combination with another modality, in patients with limited alternative options.…”