Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies

Abstract

The incidence of superior vena cava (SVC) obstruction associated with non-malignant diseases is on the rise, and a large percentage of these patients are on hemodialysis (HD). The objective was to characterize the presentation, symptoms and outcomes of HD patients with SVC obstruction identified on computerized tomography (CT) compared to patients with other etiologies such as neoplasm. A search was performed through the PACS system using key words to identify patients with SVC obstruction. The CT scans and charts were reviewed for degree of obstruction, signs, symptoms and outcomes. Thirty-six patients were included in the study. Thirteen were on HD and of these, five had symptoms associated with SVC obstruction and one had concordant findings on physical exam. In comparison, thirteen patients with a chest neoplasm had symptoms and four had concordant findings on physical exam. On follow up, 31% of the HD patients died and of these 60% were symptomatic and died within 2 years. 29% of lung cancer patients died within 16 months. The majority of the HD patients had complete SVC obstruction (85%) as opposed to those with a chest neoplasm who mostly had partial SVC occlusion (67%). In conclusion, patients on HD with SVC obstruction are less often symptomatic than those with a neoplasm. However, these HD patients had a death rate similar to the patients with cancer. This risk seems to increase in those who are symptomatic. Diagnosis of SVC obstruction by CT in HD patients may help identify those with less favorable prognosis.

Superior vena cava syndrome after creation of arteriovenous fistula

“…The reason is important because the treatment is shaped according to the reason. Removal of the catheter, anticoagulant, even thrombolytic treatment, percutaneous intervention could be the suitable treatment [6,7]. In our case patient relieved by removing the catheter so no any other procedure needed.…”

Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19

“…7 Patients with ESRD treated with chronic hemodialysis are prone to developing vascular complications, including SVC obstruction, as demonstrated in a recent retrospective computed tomography analysis indicating that 29% of subjects with arterialvenous fistulas develop central vein stenosis. 2 The pathophysiology responsible for this complication is not clear, but our patient had a long history of hemodialysisdependent ESRD before she underwent kidney transplantation. It is possible that our patient had some degree of preexisting central vein stenosis; she may have developed SVC syndrome when a large-bore ECMO cannula was inserted into an already stenotic vein as a result.…”

“…Obstruction of the superior vena cava (SVC) leading to SVC syndrome is a well described clinical entity that is most often associated with compressive, malignant tumors, but as many as 40% of cases have other causes. 1,2 Thrombus formation on foreign objects such as pacemaker wires, indwelling dialysis catheters, long-term antibiotic infusion lines have all been implicated, resulting in a combined incidence of 15,000 cases per year in the United States. 3,4 SVC syndrome due to mechanical obstruction of the SVC by veno-venous extracorporeal membrane oxygenation (VV ECMO) cannulas has been identified in children.…”

Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery

“…In the presence of infection, parenteral antibiotics should be administered. [119][120][121] Intrinsic thrombosis may be caused by fibrin sheath formation, which is the most frequent cause, thrombus on the catheter tip or thrombus in the lumen. It is associated with decreased or absent flow through one or both catheter routes.…”