Abstract
A 46-year-old woman had a transvenous pacemaker implanted through her right subclavian vein for treatment of sick sinus syndrome 2 years after beginning maintenance hemodialysis. The following year, she receved parenteral nutrition through her left subclavian vein for 12 days due to ileus which was on the same side as the atriovenous fistula. Then, she gradually developed left superior limb edema. Bilateral venography of the upper limbs, performed in 1988, showed right subclavian vein and left innominate vein occlusion and rich collateral circulation on both sides. The symptoms slowly worsened and were accompanied by headache, pigmentation of the left palm and phlebothrombosis of the left arm. Report venography revealed bilateral subclavian vein occlusion. Therefore, we performed occlusion of the atriovenous fistula and subcutaneous fixation of the left brachial artery. Two months postoperatively, all symptoms had improved and she had no difficulty with hemodialysis. In conclusion, we have to bear in mind the potential risk of subclavian vein thrombosis following subclavian vein catheterization in patients on maintenance hemodialysis, especially those who have already undergone transvenous pacemaker implantation.
