Chapter 11: Strategies for Central Vein Obstruction

Central vein obstruction remains a significant source of morbidity and mortality in hemodialysis patients. It can usually be suspected on the basis of the clinical presentation and a history of central line placement. Central vein obstruction causes swelling, discomfort and pain of the extremity associated with vascular access and dialysis. Obstruction of the superior vena cava (SVC) causes superior vena cava syndrome characterized by facial swelling, dyspnea and neck vein distention. Endovascular approach is the preferred method for treating symptomatic central vein obstruction. Selection of the proper recanalization equipment, and development of a facile catheterization and recanalization technique are essential in obtaining a successful recanalization of central vein obstruction. This chapter discusses the anatomy, imaging workup and strategies for central vein obstruction in hemodialysis patients.