Percutaneous transluminal angioplasty in the treatment of bilateral brachiocephalic vein stenosis in hemodialysis patient

Abstract

A 61-year-old male patient began to receive hemodialysis due to end-stage renal disease in diabetic nephropathy and an arteriovenous fistula (AVF) was established in the left forearm in March 2005. The patient received hemodialysis at another hospital and then swelling of the left upper limb appeared around July 2007. The patient was diagnosed as having venous hypertension and underwent ligation of the AVF because of worsening symptoms and an AVF was simultaneously established in the right forearm in January 2008. Thereafter swelling in the face and right upper extremity edema progressed, the patient was referred to our hospital in March 2010. After the patient was transferred, significant facial edema and swelling of the upper extremity were noted along with the appearance of collateral circulation in the anterior chest and neck. The patient complained of heaviness in the head and nasal obstruction. Angiography was performed due to suspicion of venous hypertension in the right AVF and tight stenosis for a length of 30mm was demonstrated in the right brachiocephalic vein. Therefore, percutaneous transluminal angioplasty (PTA) with balloon angioplasty and stent placement was performed. Left central vein stenosis or occlusion was also considered as one of the causes of facial edema. Angiography demonstrated 99% stenosis for a length of 50mm in the left brachiocephalic vein. Therefore, we performed PTA by balloon angioplasty and stent placement on the left side as well. Thereafter, facial edema and upper extremity edema improved, and clinical symptoms such as the heaviness of the head and nasal obstruction disappeared. This paper is the first report of PTA for bilateral brachiocephalic vein stenoses, and PTA by balloon angioplasty and stent placement was considered a useful treatment in this case.