Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Vascular ◽  
2022 ◽  
pp. 170853812110689
Author(s):  
Kristin Schafer ◽  
Eric Goldschmidt ◽  
Andrew Seiwert
Keyword(s):  
Upper Extremity ◽  
Venous Hypertension ◽  
Complete Relief ◽  
Surgical Removal ◽  
Central Venous ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Venous Outflow Obstruction

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient’s symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.

scholarly journals Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

2019 ◽  
Vol 12 (7) ◽  
pp. e229398
Author(s):  
Lloyd Steele ◽  
David Flowers ◽  
Simon Coles ◽  
Paul Gibbs
Keyword(s):  
Cardiac Resynchronisation Therapy ◽  
Venous Hypertension ◽  
Ptfe Graft ◽  
Pulsatile Tinnitus ◽  
Central Venous ◽  
Upper Arm ◽  
Cardiac Device ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
Arm Swelling

A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.

Intracranial Venous Hypertension and the Effects of Venous Outflow Obstruction in a Rat Model of Arteriovenous Fistula

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 341-350 ◽  
Author(s):  
Joshua B. Bederson ◽  
Otmar D. Wiestler ◽  
Oliver Brüstle ◽  
Peter Roth ◽  
Rosmarie Frick ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Rat Model ◽  
Venous Hypertension ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Venous Outflow Obstruction

Cerebral hyperperfusion and other consequences of hemodialysis central vein catheters

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S82-S83 ◽  
Author(s):  
Haimanot Wasse
Keyword(s):  
Case Reports ◽  
Venous Catheter ◽  
Venous Hypertension ◽  
Central Vein ◽  
Central Venous ◽  
Venous Circulation ◽  
Central Venous Stenosis ◽  
Cerebral Hyperperfusion ◽  
Venous Stenosis ◽  
Stage Renal Disease

While central venous stenosis is a common consequence of protracted central venous catheter use, intracardiac device transvenous leads, and central venous instrumentation, the majority of patients who develop symptomatic central venous stenosis present with characteristic venous hypertension. However, some patients may develop an abnormal intracranial venous circulation and present with neurologic symptoms. This paper will summarize findings from case reports that describe the neurologic sequelae that can develop as a result of central venous stenosis/occlusion in end-stage renal disease patients with a functional arteriovenous access.

Endovascular correction of an infantile intracranial venous outflow obstruction

2013 ◽  
Vol 12 (6) ◽  
pp. 660-663 ◽  
Author(s):  
Maryam Soltanolkotabi ◽  
Shahram Rahimi ◽  
Michael C. Hurley ◽  
Robin M. Bowman ◽  
Eric J. Russell ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Stent Insertion ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Venous Outflow Obstruction

The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization.

Styloidogenic Jugular Venous Compression Syndrome: Diagnosis and Treatment: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 783-783 ◽  
Author(s):  
Shervin R. Dashti ◽  
Peter Nakaji ◽  
Yin C. Hu ◽  
Don F. Frei ◽  
Adib A. Abla ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Pseudotumor Cerebri ◽  
Styloid Process ◽  
Clinical Results ◽  
Venous Hypertension ◽  
Diagnosis And Treatment ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Jugular Veins ◽  
Venous Outflow Obstruction

Abstract Background and Importance: Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri. Clinical Presentation: We report 2 patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction. The point of jugular compression was between the lateral tubercle of C1 and a prominent, posteriorly located styloid process. In both cases, catheter venography showed high-grade jugular stenosis at the level of C1 with an associated pressure gradient. The dominant jugular vein was decompressed after the styloid process was resected. Postoperative imaging confirmed resolution of the jugular stenosis and normalization of preoperative pressure gradients. In both cases, the symptoms of intracranial hypertension resolved. Conclusion: Intracranial venous hypertension may result from extrinsic osseous compression of the jugular veins at the skull base. Although rare, this phenomenon is important to recognize because primary stenting not only is ineffective but also may actually exacerbate the outflow obstruction. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.

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