The veno-occlusive disease of the intrathoracic central veins is a common disorder in patients with chronic renal failure under hemodialysis (HD), as a result of repeatedly vascular access in the upper limb with temporary indwelling catheters or permanent 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 varies according to the literature between 25 and 40% and has a high incidence and significant morbidity and mortality due to the risk of pulmonary embolism. [3] 

Currently, conventional venography is the gold standard for the diagnosis of this pathology. However, it’s an invasive procedure with difficult differentiation of deep and superficial venous systems, and high risks and operational costs. [4] Direct CTV has gained an important role as a screening and accurate diagnostic imaging method, compared to Doppler US and also MRI venography, due to its shorter scan time, wide availability, less operator dependency, and post-processing reconstructions. [5,6]

Interventional radiologic procedures are the primary treatments of choice in veno-occlusive disease of the intrathoracic central veins. Direct CTV provides anatomical reference, cause of obstruction, degree, and extent of the obstruction necessary for subsequent interventional procedures. [7,8]