title: Occult central venous stenosis leading to airway obstruction after subtotal parathyroidectomy.
abstract: Subtotal parathyroidectomy may be indicated in patients with chronic renal failure and tertiary hyperparathyroidism, a population at increased risk for central venous stenosis (CVS) due to repeated vascular access. Here we report a case of complete upper airway obstruction precipitated by subtotal parathyroidectomy with ligation of anterior jugular vein collaterals in a patient with occult CVS. This case demonstrates a previously unreported risk of anterior neck surgery in patients with chronic renal failure. We present a review of the literature and discuss elements of the history and physical examination suggestive of occult CVS, with additional workup proposed for appropriate cases. Recommendations are discussed for perioperative and postoperative care in patients at increased risk for CVS.
authors.affiliation: Corresponding author: Duncan A. Meiklejohn, MD, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico, 2211 Lomas Blvd., NE 2ACC, 1 University of New Mexico mSC10 5610, Albuquerque, NM 87131-0001. Email: dmeiklejohn@unm.edu From the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico, Albuquerque (Dr. Meiklejohn); the Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (Dr. Chan); and the Stanford Department of Otolaryngology-Head and Neck Surgery, Division of Otolaryngology, Santa Clara Valley Medical Center.
authors.forename: Duncan A
authors.initials: DA
authors.lastname: Meiklejohn
authors.forename: Dylan K
authors.initials: DK
authors.lastname: Chan
authors.forename: M Lauren
authors.initials: ML
authors.lastname: Lalakea
mesh_terms: D000402:Airway Obstruction / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D003097:Collateral Circulation; D003251:Constriction, Pathologic / Q000209:etiology; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D007601:Jugular Veins / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods