Upper limb edema in hemodialysis patients Upper limb edema in hemodialysis patients A single centre experienceA single centre experience
Venkatesh RajkumarApollo speciality hospitals, Chennai
•Upper limb edema is a common problem in long term hemodialysis patients•The most common etiology is venous hypertension•The site of venous obstruction varies from venous outflow tract to central veins
•To evaluate the etiology of upper limb edema•To assess the effectiveness of endovascular interventions in venous edema
• Prospective analysis (Jan 2015- Jun 2016)• All patients presenting to our dialysis unit with
isolated upper extremity swelling were included • A fistulogram was performed
Total number of patients included n=10
ETIOLOGY OF EDEMA:•Central venous stenosis(CVS) : 7 ( all left brachiocephalic)•Venous outflow tract obstruction :2 ( both were at graft vein anastomosis)•Other causes :1 ( Venous HT due to side to side Brachio basilic fistula)
PROCEDURES DONE:
• Central vein stenosis is the commonest cause of venous edema (70%) followed by venous outflow obstruction (20%).
• All the patients with central stenosis had previous history of temporary jugular catheter insertions.
• Both the cases of graft vein anastamotic stenosis responded completely to PTA and are still on follow up.
• Four out of six cases of central stenosis responded completely. Two had a partial recanalization with partial resolution of edema.
• AV fistula could be used successfully in all of the patients post angioplasty.
• Complications were mainly in the form of small hematomas (grade 1) in two patients
Aim
Introduction
METHODS
RESULTS
Patients presenting with edema (N =16)
AV Graft : 2Brachio Axillary
AV fistula : 8 Left Radio cephalic: 6 Left Ulnar basilic: 1 Left Brachio Basilic: 1
DISCUSSION
CONCLUSIONVenous stenosis presenting as upper limb edema could be effectively managed by percutaneous angioplasties on them with a very high technical and clinical success rate and with an acceptable rate of complications
ACKNOWLEDGEMENT:I hereby thank the Indian society of Nephrology and the International society of Nephrology for having helped me enter the field of Interventional Nephrology
Not willing for the procedure: 6
Patients who underwent fistulogram:10
Upper limb edema in hemodialysis patients A single centre experience
Venkatesh Rajkumar
Apollo speciality hospitals, Chennai
LEFT BRACHIOCEPHALIC STENOSIS
ATLAS 14mm Balloon
GRAFT VEIN ANASTAMOTIC STENOSIS: RT BRACHIO AXILLARY GRAFT
MUSTANG 8mm Balloon