[Thrombosis and stenosis of central venous access in hemodialysis]

Thrombosis or stenosis of the vessel is an usual complication of the long term catheterization of the veins. In hemodialysis, thrombosis and/or stenosis of the subclavian vein occur in 35% of the patients receiving a subclavian dialysis catheter. This complication is usually asymptomatic but, in some cases, the thrombosis or the stenosis of the subclavian vein leads to a painful oedema of the arm when an arteriovenous fistula is created on the same side. Sometimes, the closure of the fistula is required and a whole arm is excluded for future vascular access. Thrombosis or stenosis of central veins is significantly less frequent (3%) when the jugular veins are used for the insertion of the dialysis catheter. When the thrombosis is acute, spontaneous resolution may occur following catheter removal. When the thrombus does not resolve, anticoagulation with heparin or thrombolytic therapy with or without angioplasty has been used. Surgery with by pass of the subclavian vein may be necessary as a final option in an attempt to salvage a fistula. Taken into account these stenotic or thrombotic complications of dialysis catheters, subclavian route should be abandoned in chronic uremic patients and femoral route should be preferred for a short period access while jugular route could be used for long term temporary vascular access for hemodialysis.