ArticleFrontiers in cardiovascular medicine2025
Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: For several reasons, the incidence of superior vena cava(SVC) obstruction continues to rise, as a serious complication of hemodialysis(HD) access, and is becoming a major cause of access depletion. It is also the most difficult challenge for vascular access workers. Here we present the case of a HD patient with complete SVC occlusion, and why no intervention was made. Case presentation: A 50-year-old man on maintenance HD was admitted for markedly dilated thoracoabdominal wall veins and superficial epigastric veins. Digital subtraction angiography(DSA) revealed a complete occlusion of the SVC. Treatment options include interventional therapy, closing the arteriovenous fistula(AVF) to reduce venous pressure and creating a new lower extremity arteriovenous(AV) access, or open surgery. The patient's venous hypertension syndrome and AV access function were carefully evaluated, leading to a decision for conservative management without immediate intervention. After five years of follow-up, his left forearm AVF continues to function well, and both the AVF and superficial epigastric veins can be used for HD access. Conclusion: The management of central venous stenosis(CVS)/obstruction continues to present significant challenges. Presently, endovascular treatment is associated with low primary patency rates and a high risk of complications. Patient-centered decision-making plays a crucial role in the management of CVS/obstruction.This study provides significant insights into the conservative management in complete SVC occlusion, characterized by comparable excellent collateral compensation.
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