Abstract
Background
Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome.
Case-diagnosis/treatment
We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications.
Conclusions
In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.
References
North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) (2011) 2011 Annual dialysis report. EMMES Corp., Rockville. Available at: https://web.emmes.com/study/ped/annlrept/annualrept2011.pdf
Revel-Vilk S (2006) Central venous line-related thrombosis in children. Acta Haematol 115:201–206
Spapen HD, D'Haese J, Diltoer M, Huyghens LP (1993) Bedside evaluation of intraocular pressure in critically ill patients, ventilated at different levels of positive end-expiratory pressure. Acta Anaesthesiol Belg 44:39–43
Gomes CM, Lucon AM, Yamada RT, Gomes MC, Arap S (2000) Rare complication of an arteriovenous fistula for dialysis: glaucoma. Scand J Urol Nephrol 34:219–221
Cleper R, Goldenberg-Cohen N, Kornreich L, Krause I, Davidovits M (2007) Neurologic and ophthalmologic complications of vascular access in hemodialysis patient. Pediatr Nephrol 22:1377–1382
Black A, Lloyd-Thomas AR (1988) An unusual case of stridor. Anaesthesia 43:870–871
Srollo P, Rogers R (1996) Obstructive sleep apnea. N Engl J Med 334:99–104
Ursavaş A, Karadag M, Burgazlioglu B, Coşkun F, Ceylan E, Onart S, Gozu RO (2007) Relief from sleep apnea after radiation and chemotherapy. Clin Lung Cancer 8:502–503
Wright R, Quinones-Baldrich W, Anders A, Danovitch G (1994) Pleural effusion associated with ipsilateral breast and arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis. Chest 106:950–952
Rice TW, Rodriguez M, Barnette A, Light RW (2006) Prevalence and charachteristics of pleurl effusions in superior vena cava syndrome. Respirology 11:299–305
Hartman A, Mast H, Stapf C, Koch HC, Marx P (2001) Peripheral hemodialysis shunt with intracranial venous congestion. Stroke 32:2945–2946
Karahalios D, Rekate H, Kahayata M, Apostolides P (1996) Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198–202
Molina J, Martinez-Vea A, Riu S, Caillizo J, Barbod A, Garcia C, Peralta C, Oliver JA (1998) Pseudotumor cerebri: an unusual complication of brachiocephalic vein thrombosis associated with hemodialysis catheters. Am J Kidney Dis 31:E3
Hourigan SK, Anders R, Mitchell S, Schwartz K, Lau H, Karnsakul W (2012) Chronic diarrhea, ascites and protein-losing enteropathy in an infant with hepatic venous outflow obstruction after liver transplantation. Pediatr Transplant 16:E328–E331
Menon S, Hagler D, Cetta F, Gloviczki P, Driscoll D (2008) Role of caval venous manipulation in treatment of protein-losing enteropathy. Cardiol Young 18:275–281
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rinat, C., Ben-Shalom, E., Becker-Cohen, R. et al. Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis. Pediatr Nephrol 29, 2235–2239 (2014). https://doi.org/10.1007/s00467-014-2896-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-014-2896-2