Page 53 - Virtual Vascular Vol 6

Central Vein Stenosis

in ESRF patient on Dialysis Left brachiocephalic vein

AVF aneurysm
80% stenosis

Superior vena cava with

40% stenosis

A 60-year-old patient is having haemodialysis via a left brachiocephalic AV

fistula. In recent 6 months he noticed an increase in tortuosity and aneurysm
degeneration of his AVF. There was also increased in venous pressure during
dialysis. After dialysis, there is difficulty in haemostasis in the needling site.

There was no facial or left upper limb swelling but dilated left chest wall
superficial veins are noted. He has history of dialysis via a left central vein
cathether for 6 months before the creation of left brachiocephalic AV fistula.
A central venogram showed left brachiocephlaic vein 80% stenosis and 40% superior
vena cava (SVC) stenosis. A 14mm balloon angioplasty was performed.

Waisting

Tortuous AVF

Dilated left chest wall Balloon angioplasty

Superficial veins

52 53