Efficient haemodialysis despite complete central venous thrombosis.

Area of Science:

• Vascular Surgery
• Nephrology
• Cardiovascular Medicine

Background:

• Hemodialysis requires reliable vascular access.
• Subclavian and brachiocephalic vein thrombosis can compromise access.
• Occult venous pathology is often underestimated.

Observation:

• Two patients presented with fully functional hemodialysis access.
• Complete thrombotic occlusion of ipsilateral subclavian and/or brachiocephalic veins was incidentally discovered.
• No immediate clinical deterioration or access failure was noted.

Findings:

• Complete venous occlusion does not always preclude functional hemodialysis access.
• Asymptomatic venous thrombosis or stenosis may be more prevalent than previously thought.
• Hemodynamic compromise is the key indicator for intervention.

Implications:

• Routine screening for venous stenosis/thrombosis in hemodialysis patients may be warranted.
• Intervention for venous occlusion should be guided by clinical presentation, not solely by imaging findings.
• Conservative management can be effective in selected cases, preserving access and avoiding unnecessary procedures.