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Takahashi K, Chihara K, Ishii Y. Left innominate vein stenosis treated with graft replacement with concomitant cardiac surgery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:488-491. [PMID: 34381933 PMCID: PMC8339306 DOI: 10.1016/j.jvscit.2021.06.004] [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: 01/16/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Left innominate vein stenosis is a serious complication that causes massive venous hypertension and vascular access failure in patients requiring hemodialysis. Percutaneous transluminal angioplasty has been the standard treatment strategy; however, the outcome has been unsatisfactory, with a low primary patency rate. We present the case of a 49-year-old man with symptomatic left innominate vein stenosis that was successfully treated with graft replacement concomitantly with aortic valve replacement via median sternotomy. During surgery, appropriate cardiopulmonary bypass circulation should be established to avoid cerebral venous hypertension, which can cause irreversible brain damage.
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Affiliation(s)
| | - Kazuto Chihara
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Banasik M, Dawiskiba T, Letachowicz K, Zmonarski S, Mazanowska O, Lipiak E, Miś M, Janczak D, Krajewska M. Pleural effusion with arm, breast, and face edema as a complication of subclavian vein catheterization and arteriovenous fistula in a patient after renal transplantation: A therapeutic approach. J Vasc Access 2020; 22:1017-1020. [PMID: 32985359 DOI: 10.1177/1129729820961959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 52-year-old woman after renal transplantation developed unilateral pleural effusion as well as a massive edema of the upper limb, breast, and face as a complication of the subclavian vein catheterization and arteriovenous fistula for hemodialysis. We revealed that impaired venous drainage due to extensive vein occlusion after temporary catheter insertion, together with high venous flow from the arteriovenous fistula, were the explanation. Because of moderately impaired renal graft function and limited availability of vascular access in the patient, fistula ligation as a therapeutic method described in literature, was not an option in our case. The patient underwent an unsuccessful attempt of venous angioplasty, and eventually banding of the fistula and blood flow reduction resolved pleural effusions and edema. This is a reasonable approach to the problem of massive upper torso edema due to central vein occlusion with ipsilateral arteriovenous fistula.
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Affiliation(s)
- Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Tomasz Dawiskiba
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Edyta Lipiak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Marcin Miś
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
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Mochida Y, Ohtake T, Ishioka K, Miyake K, Moriya H, Hidaka S, Kobayashi S. Angiectasia of the parietal pleura in a hemodialysis patient with central venous stenosis and bloody pleural effusion: a case report. CEN Case Rep 2020; 10:78-82. [PMID: 32876866 DOI: 10.1007/s13730-020-00523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural effusion in hospitalized patients with long-term hemodialysis (HD) has been frequently reported. The most common causes of unilateral pleural effusions include hypervolemia, parapneumonic, uremic effusion, and malignancy. In contrast, central venous stenosis (CVS) has rarely been shown to result in pleural effusion. CVS is often diagnosed by percutaneous angiography, yet there are no reports of cases where percutaneous angiography missed CVS and instead intrathoracic endoscopy was performed. Herein, we report a case of CVS with angiectasia of the parietal pleura detected on intrathoracic endoscopy. A 62-year-old man with HD presented with massive unilateral pleural effusion. Although the cause of pleural effusion was suspected to be CVS, percutaneous angiography did not show apparent stenosis, and as a result, other potential causes of bloody effusion were investigated. The intrapleural cavity was assessed using intrathoracic endoscopy, which revealed angiectasia and no malignancy. As these findings might be suggestive of congestive and dilated vessels with venous stenosis or occlusion, 3D-computed tomography (CT) scans were performed instead of percutaneous angiography to determine whether a stenosis or occlusion was present. Brachiocephalic vein stenosis was found near the aortic arch. CVS was treated through ligation of the arteriovenous fistula (AVF), resulting in a dramatic decrease in the left pleural effusion. This case would suggest that CVS should be suspected when angiectasia of the parietal pleura is observed in HD patients. In addition, the benefit of utilizing 3D-CT should be considered when HD patients present with a unilateral hemothorax on the same side as that of the AVF, particularly when on the left side.
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Affiliation(s)
- Yasuhiro Mochida
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Takayasu Ohtake
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kunihiro Ishioka
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Katsunori Miyake
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hidekazu Moriya
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Sumi Hidaka
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Shuzo Kobayashi
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Tsuruno K, Tobino K, Sakabe M, Okahisa M, Nishizawa S, Yoshimine K, Ko Y, Ide H. Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer. Respir Med Case Rep 2020; 30:101094. [PMID: 32518745 PMCID: PMC7270597 DOI: 10.1016/j.rmcr.2020.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
We herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was diagnosed with stage IVB lung adenocarcinoma with bilateral malignant pleural effusions. A genetic analysis of the cells from pleural effusion revealed an epidermal growth factor receptor (EGFR) point mutation at exon 21 (L858R); since then, she was treated with gefitinib. Although her lung cancer and metastatic lesions had markedly reduced and the tumor cells in the pleural effusion had disappeared, pleural effusion remained. Contrast-enhanced whole-body computed tomography (CT) revealed intravenous thrombosis extending from the SVC to the left brachiocephalic and subclavian veins, and her pleural effusion was attributed to this thrombosis. Anticoagulant therapy with intravenous heparin and oral warfarin was started, nevertheless, the thrombus remained and pleural effusion did not decrease. After the placement of a pleuroperitoneal shunt, her pleural effusion resolved and her symptoms improved. This case highlights the importance of awareness of SVC or upper extremity deep vein thrombosis as a differential diagnosis of intractable pleural effusion in lung cancer patients.
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Affiliation(s)
- Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan.,Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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Khalil MAM, Rabbani MS, Chima NR, Tan J, Khalil MAU, Rehman ZU. Recurrent Brachiocephalic Vein Stenosis as a Cause for Persistent Left-sided Transudative Pleural Effusion in a Hemodialysis Patient. Ann Vasc Surg 2016; 35:208.e9-208.e13. [PMID: 27263809 DOI: 10.1016/j.avsg.2016.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/23/2015] [Accepted: 01/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis. METHODS A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem. Her dialysis duration was optimized from 2 times a week to 3 times a week for 4 hr and her dry weight was adjusted. Despite adequate dialysis for 1 month, effusion on the left side persisted. She had a previous venoplasty for a stenosis in brachiocephalic vein but restenosis occurred again. RESULTS Brachiocephalic vein stenting was performed which successfully lead to resolution of left arm swelling and left effusion. She was later on successfully transplanted. CONCLUSIONS Brachiocephalic stenosis can cause ipsilateral transudative effusion. Venoplasty and stenting of the brachiocephalic vein lead to complete resolution of effusion.
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Affiliation(s)
| | - Muhammad Sharoz Rabbani
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Noor Rehman Chima
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jackson Tan
- Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Zia Ur Rehman
- Section of Nephrology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Affiliation(s)
- Adrian Sequeira
- Division of Nephrology and Hypertension; Department of Medicine; Louisiana State University Health Sciences Center; Shreveport Louisiana
| | - Tze-Woei Tan
- Division of Vascular surgery; Department of Surgery; Louisiana State University Health Sciences Center; Shreveport Louisiana
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Hamming I, Berend K, Ajubi N, Engels R, Develter W. An unusual cause of pleural effusion in a haemodialysis patient. Clin Kidney J 2009; 2:164-6. [PMID: 25949318 PMCID: PMC4421364 DOI: 10.1093/ndtplus/sfn208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 12/18/2008] [Indexed: 11/15/2022] Open
Affiliation(s)
- Inge Hamming
- Kidney Center, University Medical Center Groningen and University Hospital Groningen, Groningen, The Netherlands
| | - Kenrick Berend
- Hemodialysis Department, St Elisabeth Hospital, Willemstad, Curaçao Netherlands Antilles
| | - Nouaf Ajubi
- Hemodialysis Department, St Elisabeth Hospital, Willemstad, Curaçao Netherlands Antilles
| | - Rauf Engels
- Hemodialysis Department, St Elisabeth Hospital, Willemstad, Curaçao Netherlands Antilles
| | - Willem Develter
- Hemodialysis Department, St Elisabeth Hospital, Willemstad, Curaçao Netherlands Antilles
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Sherman RA. Briefly Noted: Briefly Noted. Semin Dial 2005. [DOI: 10.1111/j.1525-139x.2005.00107.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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