Central vein stenosis

assoc. with longer HD duration, tunneled catheters. HeRO grafts bypass subclavian stenosis with flow into central vein (J Vasc Access 2016;17:138).

• Central vein stenosis ( CVS ) is a common complication of the central venous catheter ( CVC ) placement .
• The prevalence of CVS has mostly been studied in those who present with symptoms such as swelling of the extremity , neck and breast .
• CVS compromises arteriovenous access and can be resistant to treatment .
• A previous history of CVC placement is the most important risk factor for the development of CVS later .
• Pacemaker and defibrillator wires are associated with a high incidence of CVS .
• Increasingly liberal use of peripherally inserted central catheters ( PICC ) is likely to increase the incidence of CVS .
• The trauma and inflammation related to the catheter placement is thought to result in microthrombi formation , intimal hyperplasia and fibrotic response , with development of CVS .
• Treatment of CVS by endovascular procedures involves angioplasty of the stenosis .
• An elastic or recurrent stenosis may require a stent placement .
• The long-term benefits of the endovascular procedures , although improved with newer technology , remain modest .
• Surgical options are usually limited .
• Future studies to explore the pathogenesis and the use of novel therapies to prevent and treat CVS are needed .
• The key to reducing the prevalence of CVS is in reducing CVC placement and placement of arteriovenous accesses prior to initiating dialysis .
• Early referral of the patients to the nephrologists by the primary care physicians is important .
• Timely vein mapping and referral to the surgeon for fistula creation can obviate the need for a CVC and decrease incidence of CVS .