•This 61 yrs old gentleman is on renal replacement therapy for 8 years. He has had difficulties with hemocaccess, and several access procedures were performed on both upper extremities, including several central dialysis catheters.
•The last fistula, which is now working fine for the last 3 years is a left antecubital AV-fistula. He has had a kidney transplant 5 years ago, but the kidney has been lost due to chronic rejection after 2 years. His past medical history also includes a median laparotomy for perforated appendicitis.
•Increased swelling of the left upper arm was noted, and he has been treated several times with I.V. antibiotics for cellulitis of the left upper extremity. The patient is on coumadin.
. What are the most significant clinical findings in this patient?
. What is your provisional diagnosis and underlying etiology ?
. What imaging studies do you need for treatment planning?
. What is this imaging modality and what are the most significant findings in it ?
. What are your treatment options ?
Hemi facial edema upper limb neck swelling
2 cvo central venous occlusion_repeated access catheter
3 duplex venous out flow axillary and scv
ctv
4 ctv
Complete occlusion in nominate
5 endovascular
1 Hemi facial edema ul neck swelling
2 cvo central venous occlusion_repeated access catheter
3 duplex venous out flow axillary and scv
ctv
4 ctv
Complete occlusion in nominate
5 endo
Facial edema upper limb edema dilated chest veins chest edema site of multiple punctures in neck due to catheres
Failled multiple accesses
Q2. Central veins occlusion due as result of insertion of central cathetres
Q3 duplex scan CTV fstulogram
Q4. Fistulogram?? Occlusion of bilateral innominate vein??
Q5.
Endovascular intervention angioplasty with or without stenting
Or complex surgical bypass
Vs HeRO