title: Central venous stenosis among hemodialysis patients is often not associated with previous central venous catheters.
abstract: It is widely assumed that central venous stenosis (CVS) is most commonly associated with previous central venous catheterization among the chronic hemodialysis (HD) patients. We evaluated the validity of this assumption in this retrospective study. The clinical records from 2,856 consecutive HD patients with vascular access failure during a 5-year period were reviewed, and a total of 26 patients with symptomatic CVS were identified. Combined with radiological findings, their clinical characteristics were examined. Only seven patients had a history of internal jugular dialysis catheterization. Diagnostic multidetector row computed tomography angiography showed that 7 of the 19 patients with no history of catheterization had left innominate vein stenosis due to extrinsic compression between the sternum and arch vessels. These patients had a shorter period from the time of creation of the vascular access to the initial referral (9.2 ± 7.6 months) than the rest of the patients (35.5 ± 18.6 months, p = 0.0017). Our findings suggest that cases without a history of central venous catheterization may not be rare among the HD patients with symptomatic CVS. However, those still need to be confirm by larger prospective studies of overall chronic HD patients with symptomatic CVS.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kotoda
authors.forename: Tetsu
authors.initials: T
authors.lastname: Akimoto
authors.forename: Maki
authors.initials: M
authors.lastname: Kato
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakata
authors.forename: Taro
authors.initials: T
authors.lastname: Sugase
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogura
authors.forename: Chiharu
authors.initials: C
authors.lastname: Ito
authors.forename: Hideharu
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Muto
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy; D012189:Retrospective Studies