title: Downhill varices secondary to HeRO graft-related SVC syndrome.
abstract: Tunneled hemodialysis catheters are well-documented causes of benign central vein stenosis, which can be associated with proximal or downhill esophageal varices due to shunting of blood flow from the upper portion of the body through the esophageal venous plexuses. A majority of these cases remain asymptomatic. As a result, studies are largely limited to symptomatic patients, with incidence rates ranging from 16% to 29%. Recently, Hemodialysis Reliable Outflow (HeRO) graft has been introduced as an effective alternate hemodialysis access in catheter-dependent patients, especially in the presence of significant central venous occlusion. It differs from a conventional arteriovenous graft (AVG) by the fact that its venous outflow end is in the right atrium via one of the central veins, bypassing any significant occlusion upstream. Lower intervention rates and reduced incidence of bacteremia make it comparable to conventional tunneled catheters. However, the incidence of central vein occlusion and associated complications with HeRO grafts is unknown. We present the first case of gastrointestinal bleeding from downhill esophageal varices secondary to HeRO-graft-related SVC occlusion.
authors.affiliation: Department of Nephrology, Harper Pro Building, Wayne State University, Detroit, Michigan.
authors.forename: Unnikrishnan
authors.initials: U
authors.lastname: Pillai
authors.forename: Kahlon
authors.initials: K
authors.lastname: Roopkiranjot
authors.forename: Nandagopal
authors.initials: N
authors.lastname: Lakshminarayan
authors.forename: Krishna
authors.initials: K
authors.lastname: Balabhadrapatruni
authors.forename: Wihib
authors.initials: W
authors.lastname: Gebregeorgis
authors.forename: Paul
authors.initials: P
authors.lastname: Kissner
mesh_terms: D000368:Aged; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D013479:Superior Vena Cava Syndrome / Q000150:complications* / Q000175:diagnosis; D062666:Vascular Access Devices / Q000009:adverse effects*; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods*