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Kidney Week

Abstract: SA-PO1091

A Rare Complication of a Permanent Haemodialysis Line

Session Information

  • Vascular Access - II
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Al- Chidadi, Asmaa Y M, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
  • Perumal thiagarajan, Arun prasath, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
  • Kar, Sourjya, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
  • Arsalanizadeh, Bahareh, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom
Introduction

Starting haemodialysis via an IJ permanent line is sometimes unavoidable in late presenters. Grievious complications can sometimes happen including this rare case report.

Case Description

A 67 years old female started HD via a permanent IJV line in Sep 2013 for 18 months untill a left sided AV fistula (AVF) was created, which then went to require multiple fistuloplasties. Eventually a right sided AVF was fashioned, while the left AVF was still in place. In May 2018, she presented with extensive trunkal varicose veins. 4 weeks later, she was admitted with large-volume hematemesis and hypovolemic shock requiring Critical care admission. Emergency endoscopy showed extensive esophageal varices. A CT scan showed an SVC stenosis and a thrombus extending and involving the left AVF. There was no evidence of liver cirrhosis. This was believed to be caused by previous IJ line. Intervention was deemed unsafe because of the risk of fatal bleeding. She was then anticoagulated and dialysis resumed via a femoral permanent line.

Discussion

Central venous thrombosis is not an uncommon complication among haemodialysis population starting dialysis via permanent IJ lines. However, it is very rarely reported to cause bleeding oesophageal varices. In the case we are presenting, the additional presence of two functioning fistulae had led to extensive venous drainage into her blocked SVC and encouraged the formation of extensive collaterals, the oesophageal varices are one of them. It was technically difficult to treat the SVC stenosis but the fact that her fistulae clotted relieved some of the back pressure on the varices and reduced future bleeding risk.