Learning objectives
To illustrate theradiological findings ofcentralveno-occlusive disease withdirect CT venography (CTV).
To emphasize the importance and contribution ofdirect CTV in the diagnosis of central veno-occlusive disease in hemodialysis patients.
Background
The veno-occlusive disease of the intrathoracic centralveins is a common disorder in patients with chronicrenal failureunder hemodialysis (HD), as a result ofrepeatedly vascular access in the upper limb with temporaryindwelling catheters orpermanent native or prosthetic arteriovenous fistulas (AVF). These injuries of the endothelium, with consequent increase of smooth muscle cells and thickening of the venous wall, and rapid turbulent blood flows eventually lead to venous stenosis or occlusion of intrathoracic central veins.[1,2]
The incidence of stenosis or occlusion of the central veins in this population...
Findings and procedure details
Methods and technique
A total of 20 patients under hemodialysis with history of multiple vascular accesses and clinical suspicion ofveno-occlusive disease of theintrathoracic central veins, characterized by pain, edema and superficial collateral circulation,underwentdirect CT venography
A 128detector-row CT scannerwas used to perform all the scans. Catheterization of the peripheral distal veins is performed in both upper extremities with an 18-gauge intravenous catheter connected through a proximal and distal male luer locks extension setwiththe patient in a supine position. Two-phase iso-osmolar 70 ml iodine contrast (Ioversol...
Conclusion
Direct CTV provides greater advantages compared to other diagnostic imaging methods for the diagnosis ofveno-occlusive disease of the intrathoracicveins. Therefore, it may be considered as the first-line diagnostic method, particularly when non-permeable vascular access is suspected in patients with chronic renal failure under hemodialysis.
Personal information and conflict of interest
Dr. Erika Remenyi
Resident in training.Department of Radiology, Hospital Luis Vernaza. Loja 700 y Escobedo. Guayaquil, Ecuador.
Email:
[email protected]
References
Oguzkurt L, Tercan F, Yildirim S, Torun D. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005; 55: 237–242.
Moist LM, Al-Jaishi AA. The upfront risks of vascular access complications. J Am Soc Nephrol. 2013; 24: 1509-11.
Malhotra S, Punia V. Upper extremity deep vein thrombosis. J Assoc Physicians India 2004; 52: 237–41.
Loud PA, Katz DS, Klippenstein DL,Shah RD, Grossman ZD. Combined CT venography and pulmonary angiography in suspected thromboembolic disease: diagnostic accuracy for deep venous...
