DR JOY HONG1, Dr MICHAEL CAI1
1Royal Melbourne Hospital, Melbourne, Australia
Biography:
Joy is a current BPT at Royal Melbourne Hospital with a strong interest in pursuing nephrology training.
Background:
Central venous stenosis (CVS) is a common complication of haemodialysis access associated with central venous catheters (CVC) and less commonly seen in those with arteriovenous fistula (AVF) creation alone. CVS may lead to loss of vascular access, limit options for future vascular access and lead to overall increased morbidity and mortality.
Case Report:
A 33-year-old haemodialysis dependent male presented with acute right monocular visual change with features of papilloedema and optic neuropathy on a background of ipsilateral upper limb and facial oedema following left brachiocephalic AVF creation. Magnetic resonance angiography revealed flow reversal in the left neck veins and sigmoid and transverse dural venous sinuses, leading to contralateral venous drainage. Fistulogram displayed a severe brachiocephalic stenosis secondary to compression between the sternum and aorta, with reflux of contrast up the left internal jugular vein and drainage via right internal jugular vein. Following successful fistuloplasty with balloon dilatation and stent, there was immediate symptom improvement and resolution of papilloedema.
Conclusion:
CVS is an important differential diagnosis in patients with ipsilateral oedema and intracranial hypertension. Intervention and correction of stenosis is critical to prevent progression of symptomatology and sequalae of complications.