End-stage renal disease with venous occlusion in both upper extremities

We studied 27 patients with venographically documented bilateral subclavian vein occlusion thrombosis after the use of dual lumen hemodialysis catheters. Immediate venous access was severely limited because all patients had previously had multiple access failures. The rate of venous pressure rise between hemodialysis treatments is inconsistent in suggesting imminent thrombosis as the sole explanation for venous thrombosis, yet it is a signal to investigate vein patency. Venography may be the best method, pending further development of duplex ultrasonography. The lack of clinical symptoms warrants early use of duplex ultrasonography and venography to document subclavian vein occlusion thrombosis so that heparin and thrombolytic therapy may be initiated. Length of time between onset of pressure increase and initiation of therapy did not affect successful outcome.