title: Superior vena cava obstruction presenting with epistaxis, haemoptysis and gastro-intestinal haemorrhage in two men receiving haemodialysis with central venous catheters: two case reports.
abstract: BACKGROUND
  Superior vena cava (SVC) obstruction secondary to central venous catheterization is an increasingly recognized complication.
  
  
  METHODS
  We present two cases of superior vena cava obstruction secondary to indwelling central venous catheters used for haemodialysis access. One of the patients developed the unusual complications of torrential epistaxis and haemoptysis, which has been reported only once so far in the literature. The other patient developed melaena secondary to downhill oesophageal varices. We briefly discuss the pathophysiology, symptoms and signs, investigations and management of superior vena cava obstruction and thrombosis.
  
  
  CONCLUSIONS
  Increasing use of central venous access for haemodialysis will increase the incidence of central venous stenosis, thrombosis and exhaustion. Superior vena cava obstruction is likely to be an increasingly recognised complication of vascular access in the future.
authors.affiliation: Renal Unit, Lister Hospital Stevenage, SG1 4AB UK.
authors.forename: Seerapani
authors.initials: S
authors.lastname: Gopaluni
authors.forename: Paul
authors.initials: P
authors.lastname: Warwicker