title: Bilateral central vein stenosis in a dialysis patient with a pacemaker.
abstract: Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.
authors.affiliation: Heart Center, Sarawak General Hospital, Kota Samarahan, Sarawak, Malaysia yewkuanleong@yahoo.com.
authors.forename: Kuan Leong
authors.initials: KL
authors.lastname: Yew
authors.affiliation: Heart Center, Sarawak General Hospital, Kota Samarahan, Sarawak, Malaysia.
authors.forename: Steven
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Anesthesiology Department, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
authors.forename: Razali
authors.initials: R
authors.lastname: Farah
authors.affiliation: Heart Center, Sarawak General Hospital, Kota Samarahan, Sarawak, Malaysia.
authors.forename: Siong Hee
authors.initials: SH
authors.lastname: Lim
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002405:Catheterization, Central Venous; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D004867:Equipment Design; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008026:Ligation; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010690:Phlebography; D006435:Renal Dialysis; D012086:Reoperation; D015607:Stents; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy
keywords: Bilateral central vein stenosis; arteriovenous fistula ligation; arteriovenous shunt; bilateral upper limbs swelling; catheters; dual chamber pacemaker; indwelling; pathologic; renal dialysis; subclavian vein stenting