Superior vena cava syndrome caused by haemodialysis catheter.

Malignancy is the most common cause of the superior vena cava (SVC) syndrome. The incidence of the SVC syndrome arising from benign aetiologies is increasing and accounts for ∼35% of cases [1]. The uraemic populations, with increased use of intravascular catheters, contribute importantly to this phenomenon. We describe a haemodialysis patient with SVC syndrome due to a long-term implantation of haemodialysis catheter.

A 70-year-old female maintained on haemodialysis since 1999 had no established aetiology. Since 2004, the patient suffered repeated arteriovenous fistula (AVF) thrombosis, and a right internal jugular venous tunnelled cuffed catheter was created temporarily for dialysis. After all AVF sites failed, she used catheter for a long-term dialysis beginning in February 2007. Frequent catheter dysfunction occurred, and she underwent multiple catheter adjustments or exchanges. In October 2007, the patient presented with a 1 month history of progressive facial, neck and right upper chest swelling. Antegrade venography (Figure 1) revealed a poor inflow of contrast into the SVC at the junction of the right subclavian vein and right jugular vein with regurgitation into the right jugular vein. The neck catheter was then removed and shifted to the right femoral venous catheter. Chest computed tomography venography showed a long-segment filling defect due to venous thrombus extending from the SVC to the right atrium (Figure 2). Studies for coagulation disorder were unremarkable. Her symptoms ameliorated incompletely after a delayed initiation of anti-coagulation therapy with Coumadin.

Fig. 1

Antegrade venography revealing contrast medium regurgitation into the right jugular vein (arrow) rather than into the superior vena cava and right atrium at the tip of the Hickman catheter (arrowheads).

Fig. 2

Chest computed tomography venography. Axial image showing thrombi (arrowheads) in the superior vena cava (A) and right atrium (B). Coronal image showing multiple filling defects (arrows) due to venous thrombi extending from the superior vena cava to right atrium (C).

SVC syndrome is a very serious complication of haemodialysis catheters. Avoiding long-term use of central venous catheters and timely creation of AVF effectively prevent this complication [2]. For early recognition and timely treatment, clinicians should be aware of the increasing prevalence of SVC syndrome in uraemic population.

Conflict of interest statement. None declared.