59 yrs old patient with Left Brachio-Axillary AVG for 12 months reported ongoing high venous pressure 230mm Hg and extended bleeding after removing needles
What would be your choice of investigation required and what do you expect to see
What is your plan for intervention please
Fistulogram or CTV stenosis or occlusion of central veis system CVO
Angioplasty with or without
Q1. Fistulogram or CTV stenosis or occlusion of central veis sysytem CVO
Q2.
Angioplasty with or without stenting
Good thinking
Very good
if it is reported as a high venous pressure and prolonged bleeding, most probably it is out flow stenosis, specially if he had previous catheters in this site. routinely, i should check it first with duplex, but to be fair, it is not always conclusive. the proper management would be fistulogram with or without plasty. if it is out flow stenosis, it may be sorted by balloon angioplasty. if not, I will discuss with the patient the option of creation of another fistula in the contralateral arm or LL if possible.
Good practical answer
What would be your choice of investigation required and what do you expect to see
CTV on the neck veins and the left upper limb
Central venous stenosis or occlusion
What is your plan for intervention
Endovenous dilation with or without stenting
Very good, sometimes if Venogram is available could be less radiation and gives a lot of information
1 examination of ptn any signs of venous htn any signs of bleeding tendency
full lab CBC inr
Duplex scanning
Ctv
May be cvo
2 endovascular
Good answer, venogram could be possible alternative to CTV as it gives needed information with less radiation exposure if available