NDT Plus (2010) 3: 322–323 doi: 10.1093/ndtplus/sfq044 Advance Access publication 13 April 2010
Images in Nephrology (Section Editor: G. H. Neild)
Superior vena cava syndrome caused by haemodialysis catheter Shen-Yang Lee1, Hsiang-Hao Hsu1 and Li-Jen Wang2 1
Department of Nephrology and 2Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan Taiwan Correspondence and offprint requests to: Shen-Yang Lee; E-mail: [email protected]
Malignancy is the most common cause of the superior vena cava (SVC) syndrome. The incidence of the SVC syndrome arising from benign aetiologies is increasing and accounts for ∼35% of cases [1]. The uraemic populations, with increased use of intravascular catheters, contribute importantly to this phenomenon. We describe a haemodialysis patient with SVC syndrome due to a long-term implantation of haemodialysis catheter. A 70-year-old female maintained on haemodialysis since 1999 had no established aetiology. Since 2004, the patient suffered repeated arteriovenous fistula (AVF) thrombosis, and a right internal jugular venous tunnelled cuffed catheter was created temporarily for dialysis. After all AVF sites failed, she used catheter for a long-term dialysis beginning in February 2007. Frequent catheter dysfunction occurred, and she underwent multiple catheter adjustments or exchanges. In October 2007, the patient presented with a 1 month history of progressive facial, neck and right upper chest swelling. Antegrade venography (Figure 1) revealed a poor inflow of contrast into the SVC at the junction of the right subclavian vein and right jugular vein with regurgitation into the right jugular vein. The neck catheter was then removed and shifted to the right femoral venous catheter. Chest computed tomography venography showed a long-segment filling defect due to venous thrombus extending from the SVC to the right atrium (Figure 2). Studies for coagulation disorder were unremarkable. Her symptoms ameliorated incompletely after a delayed initiation of anticoagulation therapy with Coumadin. SVC syndrome is a very serious complication of haemodialysis catheters. Avoiding long-term use of central venous catheters and timely creation of AVF effectively prevent this complication [2]. For early recognition and
timely treatment, clinicians should be aware of the increasing prevalence of SVC syndrome in uraemic population. Conflict of interest statement. None declared.
References 1. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356: 1862–1869 2. Akoglu H, Yilmaz R, Peynircioglu B et al. A rare complication of hemodialysis catheters: superior vena cava syndrome. Hemodial Int 2007; 11: 385–391 Received for publication: 8.3.10; Accepted in revised form: 10.3.10
Fig. 1. Antegrade venography revealing contrast medium regurgitation into the right jugular vein (arrow) rather than into the superior vena cava and right atrium at the tip of the Hickman catheter (arrowheads).
© The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please e-mail: [email protected]
Superior vena cava syndrome caused by haemodialysis catheter
323
Fig. 2. Chest computed tomography venography. Axial image showing thrombi (arrowheads) in the superior vena cava (A) and right atrium (B). Coronal image showing multiple filling defects (arrows) due to venous thrombi extending from the superior vena cava to right atrium (C).
Images in Nephrology (Section Editor: G. H. Neild)
Superior vena cava syndrome caused by haemodialysis catheter Shen-Yang Lee1, Hsiang-Hao Hsu1 and Li-Jen Wang2 1
Department of Nephrology and 2Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan Taiwan Correspondence and offprint requests to: Shen-Yang Lee; E-mail: [email protected]
Malignancy is the most common cause of the superior vena cava (SVC) syndrome. The incidence of the SVC syndrome arising from benign aetiologies is increasing and accounts for ∼35% of cases [1]. The uraemic populations, with increased use of intravascular catheters, contribute importantly to this phenomenon. We describe a haemodialysis patient with SVC syndrome due to a long-term implantation of haemodialysis catheter. A 70-year-old female maintained on haemodialysis since 1999 had no established aetiology. Since 2004, the patient suffered repeated arteriovenous fistula (AVF) thrombosis, and a right internal jugular venous tunnelled cuffed catheter was created temporarily for dialysis. After all AVF sites failed, she used catheter for a long-term dialysis beginning in February 2007. Frequent catheter dysfunction occurred, and she underwent multiple catheter adjustments or exchanges. In October 2007, the patient presented with a 1 month history of progressive facial, neck and right upper chest swelling. Antegrade venography (Figure 1) revealed a poor inflow of contrast into the SVC at the junction of the right subclavian vein and right jugular vein with regurgitation into the right jugular vein. The neck catheter was then removed and shifted to the right femoral venous catheter. Chest computed tomography venography showed a long-segment filling defect due to venous thrombus extending from the SVC to the right atrium (Figure 2). Studies for coagulation disorder were unremarkable. Her symptoms ameliorated incompletely after a delayed initiation of anticoagulation therapy with Coumadin. SVC syndrome is a very serious complication of haemodialysis catheters. Avoiding long-term use of central venous catheters and timely creation of AVF effectively prevent this complication [2]. For early recognition and
timely treatment, clinicians should be aware of the increasing prevalence of SVC syndrome in uraemic population. Conflict of interest statement. None declared.
References 1. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356: 1862–1869 2. Akoglu H, Yilmaz R, Peynircioglu B et al. A rare complication of hemodialysis catheters: superior vena cava syndrome. Hemodial Int 2007; 11: 385–391 Received for publication: 8.3.10; Accepted in revised form: 10.3.10
Fig. 1. Antegrade venography revealing contrast medium regurgitation into the right jugular vein (arrow) rather than into the superior vena cava and right atrium at the tip of the Hickman catheter (arrowheads).
© The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please e-mail: [email protected]
Superior vena cava syndrome caused by haemodialysis catheter
323
Fig. 2. Chest computed tomography venography. Axial image showing thrombi (arrowheads) in the superior vena cava (A) and right atrium (B). Coronal image showing multiple filling defects (arrows) due to venous thrombi extending from the superior vena cava to right atrium (C).
