title: An unusual cause of venous hypertension after dialysis access creation.
abstract: Venous hypertension after creation of arteriovenous fistula or arteriovenous shunt occurs in approximately 10-15% of patients (Kojecky et al., Biomed Papers, 2002;146:77-79; Criado et al., Ann Vasc Surg 1994;8:530-535). Its etiology is commonly stenosis and/or thrombosis of the central venous system secondary to previous catheterization with subsequent development of venous hypertension after the arteriovenous connection is made. Treatment strategies often involve venography to determine the site of venous stenosis and/or occlusion centrally and subsequent endovascular recanalization of the stenotic or occluded veins. In this article, we report a case of venous hypertension in a 76-year-old man who presented with a swollen arm after placement of an arteriovenous fistula. In this circumstance, venography revealed extrinsic compression of the subclavian vein at the level of the first rib, the anatomic abnormality seen in venous thoracic outlet syndrome. In this report, we describe surgical and endovascular management of this patient, and review the literature on the causes of central vein stenosis discovered after creation of dialysis access.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
authors.forename: Helen Chang
authors.initials: HC
authors.lastname: Hall
authors.forename: Neil
authors.initials: N
authors.lastname: Moudgill
authors.forename: Mark
authors.initials: M
authors.lastname: Kahn
authors.forename: Richard
authors.initials: R
authors.lastname: Burkhart
authors.forename: Joshua
authors.initials: J
authors.lastname: Eisenberg
authors.forename: Atul
authors.initials: A
authors.lastname: Rao
authors.forename: Paul
authors.initials: P
authors.lastname: DiMuzio
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D004487:Edema / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010027:Osteotomy; D010690:Phlebography; D006435:Renal Dialysis; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013901:Thoracic Outlet Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014690:Venous Pressure