title: Hemodialysis Reliable Outflow device impingement in the subclavian position: a case report.
abstract: OBJECTIVE
  The purpose of this study is to report a case of Hemodialysis Reliable Outflow (HeRO) device malfunction in the subclavian position secondary to costoclavicular impingement.
  
  
  RESULTS
  The electronic medical record was reviewed for the patient in question and pertinent imaging was collected and photographs were taken with the patient's consent. The patient presented with signs of outflow obstruction after a period of HeRO venous outflow component function. The outflow component was found to be crushed between the first rib and the clavicle at the costoclavicular junction.
  
  
  CONCLUSIONS
  This case suggests that costoclavicular impingement should be considered as a mode of outflow failure with the HeRO outflow component in the subclavian position. Other central venous access points should be considered first, and the central veins accessed through the lower extremities are possible alternatives if this failure mode was to arise. First rib resection would also be a viable strategy to relieve impingement at this site.
authors: 1 Duke University School of Medicine, Durham, North Carolina - USA.
authors: John
authors: J
authors: Yerxa
authors: Shawn M
authors: SM
authors: Gage
authors: Jeffrey H
authors: JH
authors: Lawson
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency