title: Parathyroidectomy in the presence of central venous stenosis.
abstract: Hyperparathyroidism is common in the end-stage renal failure and may require surgical intervention. In addition, following multiple vascular access attempts central venous stenosis may occur. The results in high-volume venous blood flow through neck collaterals. Here, we describe a case of severe secondary hyperparathyroidism, high flow arteriovenous fistula and central venous occlusion unresponsive to radiological intervention. A four-gland exploration was undertaken and global parathyroidectomy was performed. Despite meticulous attention to haemostasis, blood loss was considerable from the skin edges although thyroid veins were easily controlled with a drop of 2.1 g/dl in haemoglobin. Postoperative hypocalcaemia requiring intravenous calcium occurred as expected from the severity of his bone disease (preoperative parathyroid hormone (PTH) 26 times the upper normal range). The patient recovered well, despite a small subcutaneous haematoma and remains asymptomatic.
authors.affiliation: Renal Surgery Department, Queen Elizabeth Hospital Birmingham, Birminhgham, UK. matthew.megson@nhs.net
authors.forename: Matthew
authors.initials: M
authors.lastname: Megson
mesh_terms: D016121:Brachiocephalic Veins; D003097:Collateral Circulation; D003251:Constriction, Pathologic / Q000150:complications; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009333:Neck; D016105:Parathyroidectomy / Q000379:methods*; D014652:Vascular Diseases / Q000150:complications*