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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Phrenic nerve palsy is a rare but important complication following central venous interventions. Patients with end-stage kidney disease (ESKD) frequently undergo central venoplasty for vascular access dysfunction, placing them at risk of procedure-related complications. Early recognition is crucial, as diaphragmatic dysfunction may exacerbate respiratory compromise in patients with significant comorbidities.
We report a case of a 78-year-old female with ESKD on hemodialysis via a right brachiocephalic arteriovenous fistula, with known right innominate vein stenosis requiring central venoplasty using a 14 × 60 mm plain balloon (Pictures 1–2). Six weeks post-procedure, she was admitted for atrial fibrillation with rapid ventricular response and was incidentally found to have a persistently elevated right hemidiaphragm on chest X-ray (Picture 3) compared to imaging three months prior (Picture 4). Further evaluation with computed tomography (CT) of the thorax, fluoroscopy sniff test, spirometry, and respiratory muscle strength testing was performed.
CT and chest radiography confirmed persistent right hemidiaphragm elevation without compressive lesions. The fluoroscopy sniff test demonstrated paradoxical upward motion of the right hemidiaphragm (Pictures 5–6), confirming right phrenic nerve palsy. Spirometry revealed a restrictive pattern with less than 20% reduction in forced expiratory volume in 1 second (FEV₁) from sitting (0.65 L) to supine (0.55 L). Maximal inspiratory pressure was reduced (74%) with normal expiratory pressure (98%), suggesting diaphragmatic weakness. Despite these findings, the patient remained asymptomatic with stable oxygenation. Conservative management with close monitoring was adopted, and she was discharged well with outpatient follow-up.
This case highlights phrenic nerve palsy as an uncommon complication of central venoplasty in a hemodialysis patient. Diagnosis requires a multimodal approach, with the fluoroscopy sniff test providing definitive evidence. Recognition of this entity is essential, as diaphragmatic dysfunction may contribute to dyspnea, recurrent infections, and increased morbidity in ESKD patients with cardiopulmonary comorbidities.
