Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy : A case report

Abstract

Introduction: Among hemodialysis population, central vein occlusion (CVO) is a common complication. Percutaneous transluminal angioplasty has become the mainstay treatment these days. But the treatment of long-segment central venous occlusion remains difficult. Patient concerns:Wepresented a 73-year-old man on maintenance hemodialysis complaining of swelling of the right armand face for 20 days. The patient underwent maintenance hemodialysis via a right internal jugular vein catheter for first 2 months of dialysis while the initial right radiocephalic wrist arteriovenous fistula (AVF) blood flow had been unsatisfactory (below 180mL/min) for 1 month. Diagnosis: Digital subtraction angiography revealed long-segment CVO extending from the right subclavian vein (SV) to the right innominate vein (IV), forming an obvious included angle at the right jugular angle. Interventions: Since conventional guide wire transversal failed, segmented sharp recanalization was performed by separate transversal of the obstructive right SV and right IV, therefore crossing the whole lesion segment by segment, followed by balloon dilation and stent placement. Outcomes: No procedure-related complication was recorded during or after the operation. After a follow-up period of 5 months, the patient's AVF maintained satisfactory in blood flow, while the edema in his ipsilateral limb and face also notably ameliorated. Conclusion: The segmented sharp recanalization is a practical strategy in treating angled long-segment CVO which is refractory to traditional guide wire transversal in hemodialysis patients. Abbreviations: AVF = arteriovenous fistula, CVO = central venous occlusion, DSA = digital subtraction angiography, IV = innominate vein, PTA = percutaneous transluminal angioplasty, SV = subclavian vein.