Percutaneous transluminal angioplasty of an in-stent re-stenosis of the right subclavian vein in a dialysis patient
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High grade in-stent restenosis. There are multiple collateral veins filling in in this venogram.
Post balloon angioplasty - good lumen restoration and disappearance of collateral venous filling.
Central venous stenosis is a relatively common problem in patients on long term haemodialysis through an AV fistula in the upper limb and may be seen in up to 40% of patients.
The clinical presentation may vary - poor flow rates at dialysis needing longer hours of dialysis, limb swelling etc.
Interventional radiology offers a good option of management of such cases either by percutaneous transluminal balloon angioplasty or stent placement. Post stenting there is a risk of in-stent restenosis due to high flows at the dialysis and at the AV fistula. In-stent restenosis can be treated by balloon angioplasty.
This case demonstrates the use of balloon angioplasty in treating in-stent restenosis.
- Oguzkurt L, Tercan F, Yildirim S, Torun D: Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005, 55:237-242
- Vascular Access Work Group: Clinical practice guidelines for vascular access. Am J Kidney Dis 2006, 48(Suppl 1):S248-S273.