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Journal of Case Reports and Images in Medicine - Journal of Case Reports and Images in Medicine - Case Reports, Case Series, Case in Images, Clinical Images

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Case Report
 
A 55-year-old female presenting with central venous stenosis
Sabrina S. Sam1, Karel T. S. Valenta1
1MS3, Northwest Hospital, Randallstown, MD, USA.

Article ID: 100008Z09SS2016
doi:10.5348/Z09-2016-8-CR-1

Address correspondence to:
Sabrina Sundari Sam
6062 Green Meadow Parkway Apt A
Baltimore, MD 21209

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How to cite this article:
Sam SS, Valenta KTS. A 55-year-old female presenting with central venous stenosis. J Case Rep Images Med 2016;2:1–4.


Abstract
Introduction: Patients who have failed arteriovenous grafts (AVG) and arteriovenous fistulas (AVF) and are central venous catheter (CVC) dependent have a new option for hemodialysis access: the hemodialysis reliable outflow (HeRO) graft. Our patient required hemodialysis for end-stage renal disease (ESRD) secondary to uncontrolled diabetes.
Case Report: A 55-year-old female presented with multiple AV fistula and AV graft failures due to venous outflow obstruction. She was catheter-dependent for hemodialysis access with evidence of central venous stenosis. The patient also presented with ventilator-dependent respiratory failure on pressure support ventilation and recurrent pleural effusions due to volume overload. With all other options exhausted, she underwent HeRO graft placement complicated by postoperative steal syndrome, and multiple thromboses.
Conclusion: The HeRO graft is an option for long-term hemodialysis access for patients who are refractory to traditional approaches and are catheter-dependent. Thrombosis and steal syndrome may be more common complications of the surgery than previously suspected, but may be manageable if caught early. In comparison to central venous catheters, with the HeRO graft, infection rates are reduced and flow rate can be increased to manage fluid overload and pleural effusions. This case report should be of interest to Nephrology and Vascular Surgery specialties.

Keywords: Catheter-dependent, Central venous stenosis, Hemodialysis access, Hemodialysis reliable outflow (HeRO) graft, Steal syndrome


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Author Contributions
Sabrina Sundari Sam – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Karel Theodore Scott Valenta – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Sabrina Sundari Sam et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.