1
|
Xiong X, Zhang H. A rare hemodialysis vascular access complication-Internal jugular vein reflux. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:456-463. [PMID: 38169054 DOI: 10.1002/jcu.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
Hemodialysis (HD) arteriovenous fistulas commonly present with late vascular access complications, but are rarely in association with internal jugular vein (IJV) reflux. We reported two patients who had severe and mild IJV reflux, respectively. Case 1 was a 48-year-old male with end-stage renal disease (ESRD) who had been treated with HD for 5 years. He presented with persistent headaches, nausea, and vomiting. Combined with all the examinations, it was revealed severe IJV reflux, brachiocephalic vein stenosis, high-flow vascular access, and IJV valve dysfunction. Case 2 was a 59-year-old female with ESRD who had constructed an AVF for 4 months and had been on HD for only 1 day. She presented with dizziness and nausea after the first hemodialysis and duplex ultrasonography showed slightly continuous IJV reflux, high-flow vascular access, and IJV valve dysfunction. Furthermore, we reviewed 16 case reports to identify the characteristics of IJV reflux in HD patients. IJV reflux in HD patients may be caused by high-flow access, central venous stenosis or occlusion, and valve dysfunction. Severe IJV reflux can develop neurological symptoms secondary to intracranial venous reflux in this article. Etiological treatment is helpful for these patients, but there is a risk of recurrence.
Collapse
Affiliation(s)
- Xiaowei Xiong
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Hongxia Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
2
|
Shiozaki E, Morofuji Y, Izumo T, Matsuo T. Retrograde Flow Into the Internal Jugular Vein in a Hemodialysis Patient Mimicking Dural Arteriovenous Fistula: A Case Report. Cureus 2024; 16:e53092. [PMID: 38414703 PMCID: PMC10897943 DOI: 10.7759/cureus.53092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/29/2024] Open
Abstract
Arterial spin labeling (ASL) and three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) are sensitive tools to detect dural arteriovenous fistula (DAVF), but hyperintensity in these images is also caused by jugular venous reflux. We present a case of a patient with renal failure on hemodialysis with retrograde flow into the internal jugular vein (IJV) mimicking DAVF. A 74-year-old man with a radial arteriovenous fistula for hemodialysis experienced transient dizziness. The TOF MRA and ASL revealed high signal intensity, suggesting the presence of a DAVF in the left transverse and sigmoid sinuses and the IJV. Digital subtraction angiography (DSA) revealed no evidence of a DAVF but showed retrograde flow into the IJV via his radial shunt. In hemodialysis patients, a high-flow shunt can cause fast retrograde flow into the dural sinuses and might lead to intracranial hypertension. The ASL images are useful for early detection and careful observation.
Collapse
Affiliation(s)
- Eri Shiozaki
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| |
Collapse
|
3
|
Ebihara K, Sato N, Ishikawa T, Endo K, Endo Y, Ohta M. Endovascular Treatment of Cerebral Venous Circulation Dysfunction Caused by Hemodialysis Shunt: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:606-611. [PMID: 37502668 PMCID: PMC10370712 DOI: 10.5797/jnet.cr.2022-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/13/2022] [Indexed: 07/29/2023]
Abstract
Objective Central venous disease, defined as ≥50% stenosis or obstruction of central veins, is one of many life-threatening complications faced by patients on hemodialysis. It often presents as upper limb edema to the arteriovenous (AV) shunt for hemodialysis, although neurological symptoms are rare. We report a case of central venous disease with neurological symptoms associated with endovascular therapy. Case Presentation A 79-year-old man presented with status epilepticus. His past medical history included rectal carcinoma when he was 69 years old and indication for hemodialysis when he was 79 years old. However, he had no history of neurological disease or epilepsy. On arrival at our facility, CT perfusion revealed venous circulation dysfunction on the left cerebral hemisphere. DSA demonstrated regurgitation from the AV shunt on left upper limb to the cerebral veins and obstruction of the left subclavian vein. Ligation of the causal AV shunt was deemed difficult due to surrounding edema; therefore, endovascular transarterial coil embolization was performed. After completely occluding the AV shunt, patient's condition improved significantly. The patient was discharged 3 days later without neurologic symptoms, with no recurrence of epilepsy was observed to date. Conclusion Coil embolization of causal AV shunt significantly improved the neurological symptoms of central venous disease.
Collapse
Affiliation(s)
- Kenichi Ebihara
- Department of Emergency Medicine, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Naoki Sato
- Department of Neurosurgery, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Toshihito Ishikawa
- Department of Neurosurgery, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Katsuhiro Endo
- Department of Neurosurgery, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Yuji Endo
- Department of Neurosurgery, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| | - Mamoru Ohta
- Department of Neurosurgery, Masu Memorial Hospital, Nihonmatsu, Fukushima, Japan
| |
Collapse
|
4
|
Hanakita S, Endo M, Saito A, Oya S. Trigeminal neuralgia due to intracranial venous reflux following central venous disease in a patient on hemodialysis: A case report. Surg Neurol Int 2022; 13:419. [DOI: 10.25259/sni_555_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/27/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
A wide variety of conditions can cause trigeminal neuralgia (TN).
Case Description:
We describe a rare case of a 77-year-old female patient on hemodialysis presenting with severe TN on the right side of the face for several weeks. She underwent multiple revisions using catheter for brachiocephalic venous stenosis over 6 years after a therapeutic arteriovenous fistula (AVF) was created in the left forearm. Her facial pain was consistent with Type 1 TN and remained intractable even after carbamazepine treatment. The initial magnetic resonance imaging did not demonstrate arterial compression on the right trigeminal nerve; instead, the vein adjacent to the right trigeminal nerve showed a hyperintense signal. In addition, the contralateral cortical veins and transverse sigmoid sinus were dilated. Angiography from the left brachial artery revealed intracranial venous reflux (IVR) through the left jugular vein due to an occluded brachiocephalic vein. Her pain was relieved immediately after her left upper arm was compressed with a sphygmomanometer to decrease the shunt. Surgical elimination of the AVF on the left forearm resulted in complete resolution of TN. Postoperative radiological examination revealed the resolution of IVR, and her TN has not recurred by her 6-month follow-up.
Conclusion:
The radiological diagnosis of IVR might be complicated because the true causative lesion for focal neurological symptoms might be remotely located. IVR following central venous disease should be a differential when patients on hemodialysis present neurological symptoms.
Collapse
|
5
|
Ito S, Taniguchi M, Uemura Y, Higuchi K. Intracranial venous reflux without the central venous occlusive disease in a patient receiving hemodialysis through brachio-brachial arteriovenous fistula: A case report. Surg Neurol Int 2022; 13:190. [PMID: 35673660 PMCID: PMC9168364 DOI: 10.25259/sni_324_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Upper-limb arteriovenous fistula as a hemodialysis access among patients with end-stage renal disease (ESRD) has become a preferred type of vascular access. However, complications involving the central nervous system may occur. There have been no reported cases of internal jugular vein (IJV) regurgitation without central venous occlusive diseases (CVODs).We describe the case of a patient on HD who presented with symptomatic IJV regurgitation without CVODs. Case Description An 83-year-old man with ESRD receiving HD through a left upper-limb AVF presented with impaired consciousness and seizures. After recovery from unconsciousness, he became alert with cognitive impairment. The left subclavian arteriography revealed early filling of the left subclavian vein due to the AVF on the left brachium, with retrograde high-flow venous reflux to the left IJV, sigmoid and transverse sinuses, with the left central veins patent. All cerebral venous drainage procedures were dependent on the right IJV. The left internal carotid arteriography showed venous congestion of the left hemisphere. The flow of the left brachial artery was measured extremely high. Under compression of the left brachial artery to reduce the flow, the regurgitation persisted. With the findings that all cerebral venous return were in the right IJV, sacrificing the left IJV was thought to be acceptable. Left IJV ligation was performed, and the patient's cognitive function improved. Conclusion The short-term outcome after IJV ligation may be positive in the patient who was confirmed to have a normal cerebral venous return route independent of the refluxed IJV.
Collapse
Affiliation(s)
- Sayaka Ito
- Department of Neurosurgery, Kohka Public Hospital, Kohka
| | - Masanobu Taniguchi
- Department of Surgery, Japanese Red Cross Nagahama Hospital, Nagahama, Japan
| | - Yuki Uemura
- Department of Cardiology, Japanese Red Cross Nagahama Hospital, Nagahama, Japan
| | - Kazushi Higuchi
- Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Nagahama, Japan
| |
Collapse
|
6
|
Caiza-Zambrano F, Palacio CM, Garbugino S, Gonzalez FM, Biolcati MB, Saucedo MÁ, Rugilo C, Forrester M, Lombi F, Pardal MF, Reisin R, Bonardo P. Central Venous Reflux, a Rare Cause of Neurological Manifestations in Hemodialysis Patients: A Case Report and Literature Review. Neurointervention 2022; 17:58-64. [PMID: 35026105 PMCID: PMC8891583 DOI: 10.5469/neuroint.2021.00444] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022] Open
Abstract
Central venous disease (CVD) is a serious complication in hemodialysis patients. Neurological manifestations are rare. We describe a female with end-stage renal disease with throbbing headache accompanied by paresthesia, weakness, and abnormal posture of her right hand during dialysis sessions. Motor symptoms completely resolved after each dialysis session, although the headaches persisted for several hours. No neurological deficit was evidenced on physical examination. Digital subtraction angiography identified an incomplete thrombosis of the left brachiocephalic vein with retrograde flow in the internal jugular vein, sigmoid sinus, and transverse sinus on the left side. This case illustrates that cerebral venous congestion due to CVD can produce neurological symptoms. Furthermore, we systematically review the literature to identify the characteristics of the cases described so far. This allows clinicians to know the entity and have a high index of suspicion in a hemodialysis patient who develops neurological symptoms.
Collapse
Affiliation(s)
| | | | - Silvia Garbugino
- Department of Interventional Neuroradiology, Hospital Británico, Buenos Aires, Argentina
| | | | | | | | - Carlos Rugilo
- Department of Neuroradiology, Hospital Británico, Buenos Aires, Argentina
| | - Mariano Forrester
- Department of Nephrology, Hospital Británico, Buenos Aires, Argentina
| | - Fernando Lombi
- Department of Nephrology, Hospital Británico, Buenos Aires, Argentina
| | | | - Ricardo Reisin
- Department of Neurology, Hospital Británico, Buenos Aires, Argentina
| | - Pablo Bonardo
- Department of Neurology, Hospital Británico, Buenos Aires, Argentina
| |
Collapse
|
7
|
Kang H, Park ST. Resolved Cerebral Venous Hypertension after Angioplasty of Central Venous Stenosis in a Hemodialysis Patient: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:206-211. [PMID: 36237346 PMCID: PMC9238213 DOI: 10.3348/jksr.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/15/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022]
Abstract
Stenosis of the central veins is a common complication in hemodialysis patients. However, cerebral venous hypertension and neurological symptoms caused by central vein stenosis are relatively rare. We present a rare case of cerebral venous hypertension in a 63-year-old male who showed venous reflux into the dural sinuses due to central venous stenosis on time-of-flight MR angiography. After management for central venous stenosis, the venous reflux disappeared.
Collapse
Affiliation(s)
- Heemin Kang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| |
Collapse
|