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[Subclavian vein stenosis in hemodialysis patients]
F Cavatorta1, S Campisi, A Zollo
1Divisione di Nefrologia e Dialisi, USL n.1 Imperiese-Ospedale, Imperia.
Insights
Subclavian vein stenosis from catheters or pacemakers can cause arm edema after hemodialysis access creation. Evaluate subclavian vein patency before creating new access in patients with prior catheters or pacemakers.
Area of Science:
- Nephrology
- Vascular Surgery
- Cardiology
Background:
- Subclavian vein catheterization and permanent pacemaker implantation are common procedures in patients requiring hemodialysis.
- Stenosis or occlusion of the subclavian vein can occur secondary to these interventions.
- Identifying predisposing factors for subclavian vein stenosis is challenging due to the absence of clear clinical findings.
Observation:
- Six hemodialyzed patients developed massive congestive arm edema after arteriovenous fistula/graft creation.
- The edema was secondary to subclavian and brachiocephalic vein stenosis.
- This stenosis was linked to previous subclavian vein catheterization and permanent cardiac pacemakers.
Findings:
- Subclavian vein stenosis is often asymptomatic and lacks identifiable predisposing factors related to catheter use.
- Pre-existing subclavian vein issues can compromise the success of arteriovenous access creation.
- Patients with a history of subclavian vein catheters or pacemakers require thorough evaluation of subclavian vein patency before new access is established.
Implications:
- Routine evaluation of subclavian vein patency is crucial for hemodialysis patients with prior interventions.
- Alternative cannulation sites, such as the jugular veins, offer reliable options for hemodialysis access.
- Discontinuation of subclavian vein cannulation is recommended in centers experiencing such complications.
Abstract:
Six haemodialyzed patient are reported in whom subclavian and brachiocephalic vein stenosis secondary to subclavian vein catheterization and to permanent cardiac pacemakers led to massive congestive edema of the same arm after an arteriovenous fistula/grafts were created. In view of the fact that subclavian vein stenosis or occlusion is not associated with any clinical findings and it is not possible to identify any predisposing factors associated with the use of the catheters, all patients who have had previous subclavian vein catheters or with permanent pacemakers should be evaluated to determine the patency of the subclavian vein before creation of a permanent access in that arm. Therapeutic answers as to haemodialysis access are discussed in these patients with permanent pacemakers who need haemodialysis. Because of all of these problems, the practice of subclavian cannulation in patients with end-stage renal failure has been discontinued in our centre. Good and reliable technology is now available for repeated short-term or long-term cannulation of the jugular veins for hemodialysis.