52 year old Male on Dialysis with Chronic Swelling of the Right Arm • Xray of the Week 2016 • Week #11
This 52 year old male with a dialysis fistula in the right arm presented with chronic swelling of the right arm. The dialysis nurse also reported decreasing efficiency of the dialysis. The patient had a venogram shown here. What has occurred and what is the treatment?
Contrast venogram via the dialysis fistula demonstrating a completely occluded right subclavian vein and no contrast entering the superior vena cava (SVC).
The guidewire has been maneuvered such that it is across the occluded segment, traverses the right atrium, and the tip is in the inferior vena cava (IVC).
A 12 mm balloon is inflated across the occluded segment in the brachiocephalic vein.
Post venoplasty. Right subclavian vein and superior vena cava are now wide open. The patient's arm swelling resolved within a few hours of the venoplasty.
A dialysis fistula is a surgically created connection between an artery and vein, usually in the upper extremity. The fistula takes about 6 weeks following surgery to mature before it can be used for dialysis. Due to the abnormal high pressure within the outflow vein, it is susceptible to stenosis or occlusion. These narrowings or blockages may be treated with balloon venoplasty as in this case. Other treatments include stents and thrombolysis, depending on the individual situation.
Kevin Rice, MD serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Van Nuys, California and is a Member of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice launched Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.
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