Superior vena cava syndrome after creation of arteriovenous fistula

Abstract

Patients with end-stage renal disease require vascular access for hemodialysis. Repeated insertions and long-term duration of permanent central venous catheters may cause venous stenosis and thrombosis in central veins, which may result in superior vena cava syndrome. A 38-year-old male patient with end-stage renal disease was admitted with complaint of dyspnea, edema of the face, neck and bilateral upper extremities. We had created a radiocephalic arteriovenous fistula at the level of left wrist two weeks ago, he had a permanent catheter in the right internal jugular vein for 2 months. The Doppler ultrasound and venographic examinations of central veins showed that the permanent catheter in the right internal jugular vein had caused the edema of the neck, face and bilateral upper extremities by narrowing the superior vena cava. The catheter was removed and the patient was anticoagulated. The patient's symptoms of shortness of breath were alleviated on hospital discharge and the swelling of the upper extremities diminished after one week. The hemodialysis patients should be directed to arteriovenous fistula surgery instead of central venous catheterization as soon as possible to avoid superior vena cava syndrome due to central venous catheters. 

Keywords

• Superior vena cava syndrome,arteriovenous fistula,central venous catheter,central venous stenosis,arteriovenous fistula,end-stage renal disease

References

1. [1] Zaki M, Hynes N, Alawy M, Sultan S. The first case using synthetic vein for jugular to iliac vein bypass to treat superior vena cava obstruction: clinical dilemma and literature review JAVA 2015;20:92-6.
2. [2] Sriramnaveen P, Kumar VS, Kishore CK, Sai Naresh VV, Sivaramakrishna G, Manjusha Y, et al. Delayed presentation of superior vena cava syndrome after hemodialysis catheter removal. Saudi J Kidney Dis Transp 2011;22:554-6.
3. [3] Akoglu H, Yilmaz R, Peynircioglu B, Arici M, Kirkpantur A, Cil B, et al. A rare complication of hemodialysis catheter: superior vena cava syndrome. Hemodial Int 2007;11:385-91.
4. [4] Williams AE, Sinha P. Arteriovenous fistula: a rare complication of peripheral venous cannulation and an example of the importance of clinical examination. Med Rep Case Stud 2016;1:105.
5. [5] Chang HH, Chang YK, Lu CW, Huang CT, Chien CT, Hung KY, et al. Statins improve long term patency of arteriovenous fistula for hemodialysis. Sci Rep 2016;6:22197.
6. [6] Cui J, Kawai T, Irani Z. Catheter-directed thrombolysis in acute superior vena cava syndrome caused by central venous catheters. Semin Dial 2015,28:548-51.
7. [7] Siegel Y, Kuker R. Superior vena cava obstruction in hemodialysis patients: symptoms, clinical presentation and outcomes compared to other etiologies. Ther Apher Dial 2016;20:390-3.
8. [8] Thapa S, Terry PB, Kamdar BB. Hemodialysis catheter-associated superior vena cava syndrome and pulmonary embolism: a case report and review of the literature. BMC Res Notes 2016;9:233.

9. [9] Sista AK, Vedantham S, Kaufman JA, Madoff DC. Endovascular interventions for acute and chronic lower extremity deep venous disease: state of the art. Radiology 2015;276:31-53.