Anatomical factors associated with left innominate vein stenosis in hemodialysis patients.

Central venous stenosis remains a challenge in hemodialysis patients. Venograms have shown that left innominate vein (LIV) stenosis often occurs in front of the trachea, where it crosses the aortic arch, suggesting that there may be an anatomical factor involved, such as iliac vein compression syndrome. The goal of this study was to determine whether LIV stenosis can be attributed to compression. From September 2008 to December 2011, 19 hemodialysis patients (ten women, nine men) with symptomatic venous hypertension of the upper-left extremity were enrolled in this study. Venography and multidetector computed tomography were used to determine the location of the venous stenosis and to assess LIV anatomy. LIV diameter and the space between the sternum and aortic arch were compared between the LIV stenosis (LIVS) group (n = 9) and the non-LIV-stenosis (NLIVS) group (n = 10). The mean age of the cohort was 63 ± 17.3 years. The mean LIV diameter was 1.69 ± 1.55 mm in the LIVS group and 8.71 ± 2.33 mm in the NLIVS group. The space between the aortic arch and sternum was smaller in the LIVS group (4.55 ± 2.67 mm) than in the NLIVS group (15.25 ± 6.12 mm, P < 0.001). A contributing factor to LIV stenosis may be due to anatomical compression of the aortic arch behind the sternum. Preoperative noncontrast computed tomography is recommended for hemodialysis patients to exclude extrinsic compression.