Percutaneous stenting of bilateral central venous occlusions in a hemodialysis patient.
Upper-extremity central venous obstruction is often first recognized when an arteriovenous fistula is made for hemodialysis at an ipsilateral site. We encountered a case of markedly expanded edema after making an arteriovenous fistula in the left forearm. Systemic venography showed that the bilateral brachiocephalic veins and right subclavian vein were occluded. Implantation of a self-expandable stent in the left brachiocephalic vein relieved the edema. However, recurrence of similar edema and occlusion of the left brachiocephalic vein were noted after 1.5 years. The left brachiocephalic vein was then recanalized by ballooning and additional stent implantation, and a stent was implanted between the superior vena cava and right subclavian vein. Simultaneous reconstruction of the bilateral central venous obstruction by percutaneous intervention rather than surgical repair was suitable for this patient because of previous thoracoplasty. We also believe that this method can provide an opportunity to select the suitable forearm for making an arteriovenous fistula, in which the ipsilateral central vein will exhibit little restenosis.
Murasato
Yoshinobu
Y
Division of Cardiovascular Medicine, Chikuho Social Insurance Hospital, 765-1 Yamabe, Nogata, 822-0034, Japan. y.murasato@chikuhou-hp.jp
Tsurugi
Takuo
T
Hiroshige
Kinya
K
Kamezaki
Fumihiko
F
Suzuka
Hiroshi
H
Kawanami
Kiyoshi
K
Suzuki
Yoshiyuki
Y
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D010690:Phlebography; D006435:Renal Dialysis; D015607:Stents