Central Venous Stenosis

Central venous stenosis or occlusion is narrowing or complete blockage of the large veins in the chest which drain blood from the arms and head back to the heart.

Central venous stenosis may occur in patients who:

Have had a catheter (tube) inserted into the jugular or subclavian veins (most common in dialysis patients).
Also occurs in patients with a pacemaker in place, made worse when there is a dialysis access in the arm on the same side.

Signs of central venous stenosis or occlusion:

In the absence of an arteriovenous fistula or graft for hemodialysis, many cases of central venous stenosis are asymptomatic or minimally symptomatic.
In the presence of an arteriovenous fistula or graft for hemodialysis, patients may develop swelling of the arm which can interfere with daily tasks or work and may make it difficult to use the dialysis access because of the swelling. Patients may also develop swelling of the face or neck.

Diagnosis:

Central venous stenosis is difficult to detect on ultrasound.
CT scan is better but unreliable.
An angiogram is the best way to confirm central venous stenosis.

Treatment:

The endovascular department offers minimally invasive diagnostic venography with angioplasty (using a balloon to open the blockage), and stenting (placing a metal scaffold) when necessary. Totally occluded (blocked) veins can often be opened, rapidly and markedly reducing swelling. These procedures are performed through small punctures in the fistula and/or groin veins, and are usually done as an outpatient.

Prognosis:

Unfortunately, central venous stenosis or occlusion tends to recur over time and requires close surveillance. Often, repeat angioplasties or stent placement is necessary to keep the veins open. With careful follow up, the central veins can often be kept open for years, preserving the use of hamodialysis access fistulas and graft on the same side of the blockage for years.