Superior Vena Cava Syndrome-like Phenomenon on Vascular Access

A septuagenarian man who had chronic renal failure was admitted to our hospital for vascular access formation.

He had a past history of thoracic and abdominal aortic aneurysm [Figure 1]. An arteriovenous fistula was made on his left forearm. After operation, the swelling of his forearm did not improve. A month later, he was initiated into hemodialysis therapy. After initiation, we performed vascular access angiography with suspicion of venous stenosis. Figure 2a is an angiography of his left subclavian vein during the phase of expiration which shows regurgitation into the cervical vein. The regurgitation occurred along with the edge of aortic aneurysm. Figure 2b is also an angiography during the phase of inspiration which did not show regurgitation. Aortic aneurysm sometimes causes superior vena cava (SVC) syndrome by compression of surrounding veins.[1,2] We considered a similar phenomenon occurred partially during only the phase of expiration. The cause of only partial compression which resulted in forearm swelling was considered to be the increase of blood flow with vascular access.

Figure 1.

An image of three-dimensional computed tomography which shows aortic aneurysm. A black arrow shows SVC. A white arrow shows thoracic aneurysm

Figure 2a.

An agiography of his left subclavian vein during the phase of expiration. Arrowheads show regurgitation into the cervical vein along with the edge of aortic aneurysm

Figure 2b.

An angiography of his left subclavian vein during the phase of inspiration which did not show regurgitation

We should take this phenomenon, not only venous stenosis, into consideration when we see swollen forearm with vascular access.