A rare hemodialysis vascular access complication-Internal jugular vein reflux

Hemodialysis (HD) arteriovenous fistulas commonly present with late vascular access complications, but are rarely in association with internal jugular vein (IJV) reflux. We reported two patients who had severe and mild IJV reflux, respectively. Case 1 was a 48-year-old male with end-stage renal disease (ESRD) who had been treated with HD for 5 years. He presented with persistent headaches, nausea, and vomiting. Combined with all the examinations, it was revealed severe IJV reflux, brachiocephalic vein stenosis, high-flow vascular access, and IJV valve dysfunction. Case 2 was a 59-year-old female with ESRD who had constructed an AVF for 4 months and had been on HD for only 1 day. She presented with dizziness and nausea after the first hemodialysis and duplex ultrasonography showed slightly continuous IJV reflux, high-flow vascular access, and IJV valve dysfunction. Furthermore, we reviewed 16 case reports to identify the characteristics of IJV reflux in HD patients. IJV reflux in HD patients may be caused by high-flow access, central venous stenosis or occlusion, and valve dysfunction. Severe IJV reflux can develop neurological symptoms secondary to intracranial venous reflux in this article. Etiological treatment is helpful for these patients, but there is a risk of recurrence.