Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review
IntroductionFor 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 c...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1645455/full |
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| author | Yanlin Zhou Bo Tu Ziming Wan |
| author_facet | Yanlin Zhou Bo Tu Ziming Wan |
| author_sort | Yanlin Zhou |
| collection | DOAJ |
| description | IntroductionFor 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 presentationA 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.ConclusionThe 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. |
| format | Article |
| id | doaj-art-51fdfdc7682945cfb19399cfc1c7199e |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-51fdfdc7682945cfb19399cfc1c7199e2025-08-20T02:39:41ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-07-011210.3389/fcvm.2025.16454551645455Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature reviewYanlin Zhou0Bo Tu1Ziming Wan2Department of Nephrology, Metabolism and Immunology Laboratory for Urological Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Nephrology, Metabolism and Immunology Laboratory for Urological Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaIntroductionFor 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 presentationA 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.ConclusionThe 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.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1645455/fullcentral venous stenosissuperior vena cava occlusionhemodialysisarteriovenous fistulaendovascular treatment |
| spellingShingle | Yanlin Zhou Bo Tu Ziming Wan Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review Frontiers in Cardiovascular Medicine central venous stenosis superior vena cava occlusion hemodialysis arteriovenous fistula endovascular treatment |
| title | Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review |
| title_full | Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review |
| title_fullStr | Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review |
| title_full_unstemmed | Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review |
| title_short | Dilated thoracoabdominal and epigastric veins in a hemodialysis patient with SVC occlusion: case report and literature review |
| title_sort | dilated thoracoabdominal and epigastric veins in a hemodialysis patient with svc occlusion case report and literature review |
| topic | central venous stenosis superior vena cava occlusion hemodialysis arteriovenous fistula endovascular treatment |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1645455/full |
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