Introduction:
Central vein stenosis is significant and frequently encountered problem in patients with maintenance hemodialysis. It is a known complication of indwelling catheters like peripherally inserted catheters, long term cuffed hemodialysis catheters, pacemaker wires. Although central venosus stenosis and occlusion are common, they are often underdiagnosed, resulting in significant long term effect such as venous hypertension leading to inadequate dialysis delivery due to recirculation, reduced AVF maturation, lower long term patency rates, superior vena cava syndrome. CVS increases with stiff non cuffed catheters primarily if used for an extended period. Therefore KDOQI guidelines suggest heir use for periods not extending for seven days. Once this condition develops management becomes a challenge. Despite percutaneous intravascular intervention being regarded as the initial therapy of choice the best management approach to achieve the highest patency still needs to be determined
Methods:
Patients on maintenance hemodialysis in our center who presented with flow related issues and venous hypertension with suspected CVS and confirmed CVS via CT venogram were taken into consideration. Patients access, dialysis vintage their clinical presentations site of obstruction, interventions done and their outcomes data were collected and analysed.
Results:
Total of 10 patients male are predominant (n=10) age varying between 30-65 years, mean dialysis vintage being 2.5 years, number of patients on tunneled catheter were 3 and rest were on AV fistula, most common presentation being venous hypertension during dialysis and flow related complications. The most common site of obstruction was left brachio-cephalic followed by left IJV and 1 patient had SVC obstruction. Of 10 patients intervention balloon angioplasty was done for 5 patients of which only 2 had salvage of the fistula and doing well on dialysis, other patients had newer access creation
Conclusions:
Hemodialysis patient with history of indwelling central venous catheter of intravascular device placement are at potential risk for central venous catheter or intra vascular device placement are at potential risk for central venous stenosis. Patients are often asymptomatic, but appropriate diagnostic investigations should be considered in those with clinical suspicion. Treatment is reserved for clinically significant lesions and percutaneous angioplasty is the preferred initial form of therapy.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.