Brachiocephalic Vein Occlusion from a Tunneled Hemodialysis Catheter

Abstract

An 81-year-old woman on hemodialysis was admitted for right forearm arteriovenous graft (AVG) thrombosis. One year before admission, a tunneled hemodialysis catheter had been placed in the right jugular internal vein. This catheter had been removed and an AVG created six months before admission. Computed tomography revealed occlusion of the right brachiocephalic vein and jugular internal vein (asterisk and arrow, Picture 1). These occlusions were considered to have been caused by the tunneled hemodialysis catheter (1). To restore the AVG blood flow, angiography was performed, which revealed collateral circulation that preserved the right arm blood flow (arrow, Picture 2). The chronic total occlusion of the right brachiocephalic vein was recanalized, and a stent was implanted (Picture 3) (2). The unnecessary use of a tunneled hemodialysis catheter should be avoided due to risks of central venous occlusion, and angiography before AVG placement is helpful for designing AVGs in the opposite arm.