Page 63 - Virtual Vascular Vol 14

Inspection:

Dark Uremic skin

Central line for haemodialysis

Scar in left snuffbox region for previous AVF creation

 End stage renal failure

Left arm swelling compared to right
Ddx: Central vein obstruction; e.g. DVT, central vein stenosis (central

vein catheter in situ may cause this)
Other ddx include post axillary dissection lymphoedema (but no

mastectomy scar)

Also examine:
- Concomitant head and neck swelling may indicate brachiocephalic

vein stenosis rather than subclavian vein stenosis

- Any left arm AV fistula/graft with thrill

- Left axilla for any previous scar or lymphadenopathy

- Left breast for any mass

Further investigation:

- Ultrasound (to look for DVT)

- Contrast CT venogram of the thorax (to look for site and cause of

central vein stenosis)

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