The potential risk for subclavian vein occlusion in patients on haemodialysis

Subclavian vein (SCV) stenosis or occlusion can be a late complication of temporary haemodialysis or following catheterisation for intravenous hyperalimentation. In five patients with prior catheterisation or trauma of the SCV, incapacitating oedema of the upper extremity developed only after the creation of ipsilateral arteriovenous (AV) fistulas for haemodialysis. The duration of the previous catheterisation was 2 to 4 weeks. Massive upper extremity oedema developed at 10 days to 22 months with an average of 11 months after the establishment of AV fistulas. Subclavian-axillary vein bypass using a ringed polytetrafluoroethylene graft was successful for one patient and ligation of the AV fistulae led to good results for the other three. In planning vascular access procedures in the upper extremity, venography should be mandatory to try to prevent such complications if a previous history of subclavian catheterisation exits.