UNMASKING PAGET-SCHROETTER SYNDROME: THE HIDDEN RISK OF AVF CREATION.

Introduction:

Paget-Schroetter syndrome(PSS) is venous variant of thoracic outlet syndrome. There is compression and thrombosis of deep veins of upper limb, i.e. axillary and subclavian veins at the thoracic inlet. AVF creation is the lifeline for dialysis in CKD patients. AVF creation is recommended in patients with eGFR less than 20ml/min/1.73m2.

Methods:

We herein report a case of a 43 year old female who presented to outpatient department at Institute of Nephro-Urology, Bengaluru, with diffuse swelling of left arm for last two weeks. She was case of chronic kidney disease stage IV secondary to chronic glomerulonephritis. She was advised AVF creation as per recommendations and underwent Left Brachio-cephalic AVF creation. She developed diffuse edema over her left arm the next day. The swelling progressed over next one week after which it remained static with no other signs of inflammation. There was no prior history of any vascular procedure or catheterisation. No past history of any thrombotic or embolic events was ever reported. Thrombophilia or any anatomic anomaly at thoracic outlet was ruled out. No previous history of catheter insertions.

Results:

She underwent fluoroscopy guided fistulogram and central venogram, which revealed complete thrombosis of left axillary vein. Subsequently she underwent venous mapping of the right side which showed complete right subclavian thrombosis. She was given anticoagulants for the same.

Conclusions:

PSS is a rare syndrome which may be unmasked by AVF creation due to increased blood flows and pressures. The clinicians must be aware of this entity and merits Pre-AVF evaluation for venous anomalies.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.