title: Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient - Case Report and Literature Review.
abstract: BACKGROUND
  Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains.
  
  
  METHODS
  61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by "body floss" technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self - expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center.
  
  
  CONCLUSIONS
  Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Róża
authors.initials: R
authors.lastname: Krycińska
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Trznadel
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Paulina
authors.initials: P
authors.lastname: Kuchalska
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Lis
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Dołęga-Kozierowski
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Dyś
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Drelichowski
authors.affiliation: Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Witkiewicz
keywords: Arteriovenous Fistula; Radiology, Interventional; Renal Insufficiency, Chronic; Superior Vena Cava Syndrome