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Schultz H, Bacorn C, Cristiano BC, Carey AR, Carper MG, Gailloud P, Miller NR, Campbell AA. Bilateral Dilated Superior Ophthalmic Veins in a Patient With an Arteriovenous Dialysis Fistula. Ophthalmic Plast Reconstr Surg 2024; 40:e19-e23. [PMID: 37721308 DOI: 10.1097/iop.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
A 64-year-old man presented with 4 months of diplopia. He had end-stage renal disease requiring a cephalic transposition brachiocephalic fistula that was no longer in use following successful renal transplantation. On presentation, he had bilateral proptosis, extraocular movement restriction, chemosis, tortuous episcleral vessels, and caruncular injection. Non-contrast CT of the orbits demonstrated dilation of both superior ophthalmic veins, and CT angiography showed asymmetric enlargement of both cavernous sinuses and superior ophthalmic veins. A carotid-cavernous fistula was suspected, but cerebral angiography revealed shunting from the old fistula with intracranial drainage and cerebral venous hypertension. Aberrant retrograde drainage resulted from anatomical compression of the left brachiocephalic vein. The fistula was ligated, and at 1-week follow-up, the patient had marked improvement in extraocular movements and orbital congestion with near complete resolution of diplopia. Postoperative CT angiography obtained 2 months later demonstrated decreased size of both superior ophthalmic veins, consistent with improvement of venous hypertension.
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Affiliation(s)
- Hannah Schultz
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Colin Bacorn
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Brian C Cristiano
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Andrew R Carey
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Michael G Carper
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Philippe Gailloud
- Department of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Neil R Miller
- Department of Ophthalmology, Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ashley A Campbell
- Division of Oculoplastic Surgery, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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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.
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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
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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.
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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
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Damante MA, Huntoon KM, Schunemann VA, Ikeda DS, Youssef PP. Venous infarction secondary to congestive encephalopathy from central venous occlusive disease in a chronic hemodialysis patient: A case report. Brain Circ 2021; 7:277-280. [PMID: 35071845 PMCID: PMC8757506 DOI: 10.4103/bc.bc_49_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/19/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
Central venous occlusive disease secondary to chronic hemodialysis catheterization rarely progresses to encephalopathy, cerebral infarction, and/or hemorrhage. A 59-year-old male with 15 years of haemodialysis-dependent end-stage renal disease presented with acutely altered mental status, extensor rigidity with left hemiparesis and equal, but small and nonreactive pupils. Magnetic resonance imaging demonstrated infarction and cerebral edema. Cranial angiogram through right brachial artery injection revealed right subclavian vein opacification via a patent AV-fistula and retrograde flow to the right internal jugular vein and superior sagittal sinus secondary to occlusion of the brachiocephalic vein. All cerebral and right upper extremity venous drainage occurred via the contralateral venous outflow tract. Internal carotid artery injections revealed significant venous congestion. Despite successful angioplasty with stenting and resolution of venous flow reversal, the patient failed to recover neurologically. The devastating nature of the presented case emphasizes the need for frequent neurologic evaluation of such patients to avoid catastrophic cerebrovascular injury.
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Affiliation(s)
- Mark A Damante
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristin M Huntoon
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Victoria A Schunemann
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Patrick P Youssef
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Sutraye J, Kannam M, Ponnapalli SP, Sachdeva V. Disc Oedema in A Patient with Chronic Kidney Disease: A Diagnostic Conundrum. Neuroophthalmology 2021; 46:34-40. [DOI: 10.1080/01658107.2020.1867872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Jagadeesh Sutraye
- Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
| | - Mohan Kannam
- Academy of Eye Care Education, Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
| | | | - Virender Sachdeva
- Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
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Mazzola MA, Ramineni A, Burns JD, Lerner DP. Reversible Encephalopathy Due to Venous Hypertension From Arteriovenous Hemodialysis Graft. Neurohospitalist 2020; 11:175-180. [PMID: 33791065 DOI: 10.1177/1941874420971933] [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: 11/15/2022] Open
Abstract
Venous congestive encephalopathy is a rare complication in patients with arteriovenous hemodialysis grafts. It commonly manifests as encephalopathy of fluctuating severity, often with seizures. Because these patients typically have multiple significant chronic health problems, venous hypertension's contribution to the patient's cognitive decline can easily be overlooked. This nonspecific presentation can make diagnosis challenging, therefore delaying treatment. We describe a case of progressive, fluctuating encephalopathy with seizures due to cerebral venous congestion caused by arterial shunting from an upper limb arteriovenous (AV) fistula to the proximal venous system, that was initially unrecognized, yet ultimately reversed by elimination of the source of venous hypertension.
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Affiliation(s)
- Maria Antonietta Mazzola
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA.,Beth Israel Lahey Health, Burlington, MA, USA
| | - Anil Ramineni
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA.,Beth Israel Lahey Health, Burlington, MA, USA
| | - Joseph D Burns
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA.,Beth Israel Lahey Health, Burlington, MA, USA
| | - David P Lerner
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA.,Beth Israel Lahey Health, Burlington, MA, USA
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deFreitas D, Moss J. Innominate vein stenosis causing raised intracranial pressure and blindness. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:282-284. [PMID: 32548364 PMCID: PMC7283974 DOI: 10.1016/j.jvscit.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 11/02/2022]
Abstract
Central venous stenosis causing elevated intracranial pressure is a rare and potentially reversible cause of blindness in patients undergoing hemodialysis. We present the case of a 69-year-old man with progressive vision loss and raised intracranial pressure that was successfully treated with an innominate vein stent.
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Affiliation(s)
- Dorian deFreitas
- Department of Vascular and Endovascular Surgery, UNC Rex Hospital, Raleigh, NC
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