Venous hypertension associated with arteriovenous hemodialysis access.

Abstract:

:Venous hypertension is a significant problem for the patient on chronic hemodialysis. This condition can result in impairment of arteriovenous access function, disabling upper extremity edema with bluish discoloration and pigmentation of the skin, and, in advanced cases, ulceration of the finger tips and neuralgias. Venous hypertension usually results from central vein stenosis or valvular incompetence in the arteriovenous access outflow vein. A high index of suspicion is required to identify patients at risk for venous hypertension. A history of ipsilateral central venous catheter placement, or physical signs such as visible distended shoulder venous collaterals, and upper extremity edema are suggestive. Diagnosis is confirmed with Duplex ultrasound or contrast venography. The primary goal of diagnosis and therapy of venous hypertension is symptomatic relief while maintaining the functionality of the access. Treatment includes percutaneous catheter-based and open surgical techniques. Open surgical techniques, while more invasive, remain the gold standard as long-term patency after angioplasty, with or without covered stents, remains unproven.

journal_name

Semin Vasc Surg

authors

Neville RF,Abularrage CJ,White PW,Sidawy AN

doi

10.1053/j.semvascsurg.2003.11.002

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

50-6

issue

1

eissn

0895-7967

issn

1558-4518

pii

S0895796703000644

journal_volume

17

pub_type

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