Causes and exacerbating processes include intravascular CVC, deep venous thromboses, pacemakers and other cardiac rhythm devices, as well as the presence of the hemodialysis AV access itself [4,5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest There is consensus that central vein occlusions and stenoses that develop in the outflow track of a dialysis access ought to be treated in the setting of handicapping extremity edema [110]. A high index of suspicion, particularly in patients with a history of multiple prior catheter placements or chronic dialysis catheter use, may lead to a clinical diagnosis of CVS. While meticulous physical examination may demonstrate limb or breast swelling and neck or chest wall collaterals, the definitive diagnosis of CVS is made on angiography [111]. Diagnostic fistulography allows for angiographic visualization of a culprit lesion resulting in the noted swelling of the ipsilateral extremity. However, given that a symptomatic CVS is primarily treated with PTA, a single intervention may facilitate both definitive diagnosis of the suspected CVS and its treatment [112]. US Duplex Doppler Hemodialysis Access Area of Interest Duplex US has been cited as suboptimal for the diagnostic assessment of the central veins in part secondary to interference by the enveloping bony thorax as well as due to overlapping soft tissue in obese individuals [111]. However, color flow duplex US negates the need for use of radiocontrast and can also suggest the presence of CVS when there is absent respiratory variation in vessel diameter, a lack of polyphasic atrial waves, and depiction of regional venous collaterals. Data also suggests that duplex US may be used in select patients to identify a culprit CVS requiring an intervention, but also as a means of monitoring the durability of success posttreatment [113].
Dialysis Fistula Malfunction. Causes and exacerbating processes include intravascular CVC, deep venous thromboses, pacemakers and other cardiac rhythm devices, as well as the presence of the hemodialysis AV access itself [4,5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest There is consensus that central vein occlusions and stenoses that develop in the outflow track of a dialysis access ought to be treated in the setting of handicapping extremity edema [110]. A high index of suspicion, particularly in patients with a history of multiple prior catheter placements or chronic dialysis catheter use, may lead to a clinical diagnosis of CVS. While meticulous physical examination may demonstrate limb or breast swelling and neck or chest wall collaterals, the definitive diagnosis of CVS is made on angiography [111]. Diagnostic fistulography allows for angiographic visualization of a culprit lesion resulting in the noted swelling of the ipsilateral extremity. However, given that a symptomatic CVS is primarily treated with PTA, a single intervention may facilitate both definitive diagnosis of the suspected CVS and its treatment [112]. US Duplex Doppler Hemodialysis Access Area of Interest Duplex US has been cited as suboptimal for the diagnostic assessment of the central veins in part secondary to interference by the enveloping bony thorax as well as due to overlapping soft tissue in obese individuals [111]. However, color flow duplex US negates the need for use of radiocontrast and can also suggest the presence of CVS when there is absent respiratory variation in vessel diameter, a lack of polyphasic atrial waves, and depiction of regional venous collaterals. Data also suggests that duplex US may be used in select patients to identify a culprit CVS requiring an intervention, but also as a means of monitoring the durability of success posttreatment [113].