title: Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis.
abstract: BACKGROUND
  Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome.
  
  
  METHODS
  We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications.
  
  
  CONCLUSIONS
  In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.
authors.affiliation: Division of Pediatric Nephrology, Shaare Zedek Medical Center, The Hadassah-Hebrew University School of Medicine, POB 3235, Jerusalem, 91031, Israel, chrinat@szmc.org.il.
authors.forename: Choni
authors.initials: C
authors.lastname: Rinat
authors.forename: Efrat
authors.initials: E
authors.lastname: Ben-Shalom
authors.forename: Rachel
authors.initials: R
authors.lastname: Becker-Cohen
authors.forename: Sofia
authors.initials: S
authors.lastname: Feinstein
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Frishberg
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007673:Kidney Cortex Necrosis / Q000150:complications / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D014525:Urethral Stricture / Q000150:complications / Q000628:therapy