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Kidney Week

Abstract: PO1362

Missed Central Venous Stenosis Causing Unilateral Arm Swelling

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Author

  • Barnes, Sylvester, Loyola University Health System, Maywood, Illinois, United States
Introduction

The patient is a 67YOM with a history of ESRD, right mandible SCC treated with resection, chemotherapy, and radiation with a right sided PowerPort placed for chemo, removed after roughly 1 year. Prior to initiation of dialysis the patient had a right upper extremity brachiocephalic fistula created leading to unilateral right arm swelling shortly afterwards.

Case Description

Fistulogram was performed showing no significant stenosis. Persistent arm swelling continued. CT venogram showed no areas of central stenosis nor any external mass compression (figure 1). Repeat fistulogram showed similar findings; however, pressure wire measurement was obtained showing a gradient of 20 mmHg at the right innominate/SVC junction. Catheter directed injection revealed a near complete stenosis (figure 2). Angioplasty was performed with an 8 mm balloon. Repeat pressure measurements showed a decrease to 10 mmHg with angiogram demonstrating significant improvement in the lesion.

Discussion

Over two weeks he had swelling resolution. This case highlights physical exam findings of central vein stenosis. Despite being absent on multiple imaging modalities persistent physical exam findings necessitated continued evaluation. The validity of pressure wire measurements to help guide further imaging and treatment options is also highlighted.