1Roshan Valentine, 1Reddi Prasad Yadavalli

1Manipal Hospital, Bangalore, India

Background:

Thoracic central venous system comprises of the deep venous system continuing from the head, neck, upper limb to the heart through the thoracic inlet corresponding to the level of T1 vertebra. These include the Superior vena cava (SVC), Brachiocephalic vein(BCV), subclavian vein(SCV), intrathoracic segment of Internal Jugular Vein(IJV) and suprahepatic Inferior Vena Cava(IVC). Stenosis of these vessels are not infrequent with most common cause being  multiple punctures while cannulating the IJV or SCV. The other causes include turbulent flow secondary to AV shunts, thrombin sheath formation within the indwelling catheters. Clinically they present with ipsilateral arm or face swelling, increased venous pressure during hemodialysis(HD) and failed access. Rather than the conventional treatment options, endovascular management remains as a standalone promising treatment option. In this pictorial exhibit, we present 4 patients with central venous stenosis who were referred to Interventional Radiology department for endovascular management.

Material(s) and Method(s):

Retrospective analysis of the patients referred to our department of Interventional Radiology for management of  central venous disease was performed during the last 6 months. Only cases with Angiographically confirmed stenosis were included.

Result(s):

All the four patients described in the case series showed satisfactory resolution of their complaints including facial and limb swelling, chest wall collaterals and increased venous pressures.

Conclusion(s):

Thoracic central venous obstruction is fairly common in patients with central venous catheters and high flow pressure within these catheters is considered its Achilles Heel. Percutaneous Transluminal Angioplasty is an essential component in the dialysis access armamentarium and has become the de-facto choice in case of central venous disease.