title: Central Venous Occlusion in the Hemodialysis Patient.
abstract: Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients.
authors: Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
authors: Vinay Narasimha
authors: VN
authors: Krishna
authors: Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, AL.
authors: Joseph B
authors: JB
authors: Eason
authors: Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: mdallon@uab.edu.
authors: Michael
authors: M
authors: Allon
mesh_terms: D062905:Central Venous Catheters / Q000009:adverse effects*; D003251:Constriction, Pathologic; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014652:Vascular Diseases / Q000209:etiology*
keywords: Central vein stenosis; central venous catheters; end-stage renal disease (ESRD); fistulogram; hemodialysis; occlusion; percutaneous transluminal angioplasty; stents; thrombosis