patient has a tunneled hemodialysis catheter in her left internal jugular vein and has had multiple...
TRANSCRIPT
Patient has a tunneled hemodialysis catheter in her
left internal jugular veinand has had multiple episodes
of catheter dysfunction due to formation of a fibrin sheath
fibrin sheath
hemodialysis catheterhas been removed
left IJ
Fibrin sheath andleft brachiocephalic vein
have been dilated several times
Due to the long-termpresence of the tunneled
hemodialysis catheterthere is a persistent
stenosis in theleft brachiocephalic vein
This central venous stenosis.in combination with her
new left upper arm fistula,is the etiology of herpersistent left upperextremity swelling
A good management plan would be to remove thetunneled hemodialysis catheter from the left internal jugular vein
and then to dilate (PTA) and stent the stenosis in the left brachiocephalic vein to alleviate the left arm edema.
To do so requires moving the hemodialysis catheter to a new location. Ultrasound demonstrated that the right internal jugular
vein is occluded. The right subclavian vein may be an optionif the right upper extremity veins are not useable for future
vascular access procedures.
A right upper extremity venogram was performed.
Right elbow region
basilic vein
cephalic vein
Right upper arm veins
basilic vein
cephalic vein
Right shoulder region
basilic vein
cephalic vein
subclavian vein
Moderate stenosis of mid-subclavian veindue to extrinsic compression of vein
between 1st rib and right clavicle
The right basilic vein is in decent shape and could beused for a future fistula or graft. Therefore, we would not want to jeopardize the right subclavian by using
it for a new tunneled hemodialysis catheter.
The next option would be to remove the currentleft-sided tunneled hemodialysis catheter and place a
new tunneled hemodialysis catheter into a femoral vein.This option should be discussed with the patient.