Letter to the Editor
Oesophageal varices secondary to thrombosis of the superior vena cava due to jugular haemodialysis catheter
Varices esofágicas secundarias a trombosis de vena cava superior por catéter yugular para hemodiálisis
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"idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Oesophageal varices secondary to thrombosis of the superior vena cava due to jugular haemodialysis catheter" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "458" "paginaFinal" => "459" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Isabel Morales García, María Dolores Arenas Jiménez, Rafael José Esteban de la Rosa, Rafael Fernández-Castillo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana Isabel" "apellidos" => "Morales García" "email" => array:1 [ 0 => "amoralesg@senefro.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Arenas Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Rafael José" "apellidos" => "Esteban de la Rosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Rafael" "apellidos" => "Fernández-Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Complejo Hospitalario de Granada-IBS de Granada, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Perpetuo Socorro de Alicante, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Varices esofágicas secundarias a trombosis de vena cava superior por catéter yugular para hemodiálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 771 "Ancho" => 995 "Tamanyo" => 127909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Venogram image that shows cava thrombosis and significant collateral circulation through the azygos system.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A priority for nephrologists in haemodialysis (HD) is preserving their patient venous resources. Vascular access guidelines recommend a prevalence <10% of central venous catheters (CVCs) in HD units. However, this number is increasing at a disquieting rate.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The main cause of superior vena cava thrombosis in HD is placement of a CVC. The incidence of thrombosis in patients with a CVC ranges from 1% to 66%<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a> depending on the catheter type, catheter location, diagnostic criteria and study population. A very uncommon form of presentation of superior vena cava thrombosis is reported in HD. Very few cases have been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 28-year-old male with CKD secondary to reflux nephropathy who started HD at age 11 through a left radiocephalic arteriovenous fistula (AVF). After a decade had passed since he underwent transplantation, he restarted dialysis through a left humeral–cephalic (HC) AVF that thrombosed after resection of an aneurysm and interposition of a PTFE prosthesis. He underwent placement of a right jugular tunnelled venous catheter (CVC), which was removed a year later, once ensured that his right HC-AVF was functioning properly. Incidentally, an angio-CT scan performed for a kidney transplant protocol showed thickening in the distal wall of the oesophagus, and multiple retroperitoneal lymphadenopathies with a diffuse distribution. An endoscopy revealed 3 varicose vessels in the distal third of medium size. Portal vein thrombosis and chronic liver disease were ruled out. The patient started with beta-blockers (nadolol 20<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h). At that time, the patient had partial thrombosis of his right HC-AVF, and a PTFE prosthesis was interposed in his old left HC-AVF. Two weeks later, a first episode of acute gastrointestinal bleeding (AGIB) occurred owing to oesophageal varices with severe anaemia (Hb 4.9<span class="elsevierStyleHsp" style=""></span>g/l). It was not possible to perform a haemodynamic study due to an interposition of jugular lymphadenopathies. These were studied along with the retroperitoneal lymphadenopathies that were identified as benign.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After 10 months had passed since the first episode of AGIB, a second episode occurred. A gastroscopy showed an increase in the number and size of varicose veins (4 varicose veins, 2 of them large). The 2 largest varicose veins were banded with 5 oesophageal bands, but one month later a third episode of AGIB occurred owing to varices. On this occasion, 5 varices were identified, 2 with recent marks of ligation and 3 of medium size. A neck CT scan performed a year earlier, during a lymphadenopathy study, revealed superior vena cava thrombosis, immediately before the cava entered the right atrium, that obliterated the lumen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He was recannulated using angioplasty, with no complications and with regression of the number and size of the varices (3 of small size). The prothrombotic pathology study was negative. Currently, the patient has been asymptomatic for a year and a half. He undergoes endoscopic monitoring every 6 months, with stabilisation of the varices.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In this case, the aetiology of the oesophageal varices was superior vena cava thrombosis secondary to a catheter, which increased the drainage pressure of the azygos vein and had shifted backwards, causing the varices. An increase in the venous system flow rate, caused by the interposition of a PTFE prosthesis in the old left HC-AVF when partial thrombosis of the right HC-AVF occurred, made the varices increase in number and size, and triggered the first episode of gastrointestinal bleeding a week afterwards.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The placement of a CVC for HD is not free of immediate and late complications. This example of an unusual complication linked to catheters for HD has illustrated the need to avoid their use to the extent possible.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morales García AI, Arenas Jiménez MD, Esteban de la Rosa RJ, Fernández-Castillo R. Varices esofágicas secundarias a trombosis de vena cava superior por catéter yugular para hemodiálisis. Nefrologia. 2016;36:458–459.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 771 "Ancho" => 995 "Tamanyo" => 127909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Venogram image that shows cava thrombosis and significant collateral circulation through the azygos system.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guías de acceso vascular en hemodiálisis (Guías SEN)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. 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Bassot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2203001181" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2001" "volumen" => "220" "paginaInicial" => "655" "paginaFinal" => "660" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11526263" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Formation of downhill esophageal varices as a rare but serious complication of hemodialysis access: a case report and comprehensive literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.A. Hussein" 1 => "N. Mawla" 2 => "A.S. Befeler" 3 => "K.J. Martin" 4 => "K.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 53 | 48 | 101 |
| 2024 September | 53 | 29 | 82 |
| 2024 August | 72 | 47 | 119 |
| 2024 July | 47 | 30 | 77 |
| 2024 June | 45 | 25 | 70 |
| 2024 May | 54 | 37 | 91 |
| 2024 April | 49 | 22 | 71 |
| 2024 March | 31 | 23 | 54 |
| 2024 February | 39 | 29 | 68 |
| 2024 January | 24 | 20 | 44 |
| 2023 December | 30 | 23 | 53 |
| 2023 November | 49 | 25 | 74 |
| 2023 October | 80 | 33 | 113 |
| 2023 September | 67 | 23 | 90 |
| 2023 August | 37 | 24 | 61 |
| 2023 July | 47 | 23 | 70 |
| 2023 June | 40 | 15 | 55 |
| 2023 May | 62 | 31 | 93 |
| 2023 April | 23 | 10 | 33 |
| 2023 March | 39 | 18 | 57 |
| 2023 February | 31 | 19 | 50 |
| 2023 January | 34 | 16 | 50 |
| 2022 December | 64 | 26 | 90 |
| 2022 November | 61 | 19 | 80 |
| 2022 October | 85 | 37 | 122 |
| 2022 September | 53 | 32 | 85 |
| 2022 August | 47 | 40 | 87 |
| 2022 July | 39 | 41 | 80 |
| 2022 June | 45 | 27 | 72 |
| 2022 May | 32 | 30 | 62 |
| 2022 April | 40 | 40 | 80 |
| 2022 March | 41 | 40 | 81 |
| 2022 February | 35 | 36 | 71 |
| 2022 January | 42 | 34 | 76 |
| 2021 December | 41 | 38 | 79 |
| 2021 November | 40 | 40 | 80 |
| 2021 October | 41 | 34 | 75 |
| 2021 September | 66 | 37 | 103 |
| 2021 August | 49 | 32 | 81 |
| 2021 July | 49 | 35 | 84 |
| 2021 June | 44 | 43 | 87 |
| 2021 May | 40 | 33 | 73 |
| 2021 April | 62 | 32 | 94 |
| 2021 March | 37 | 24 | 61 |
| 2021 February | 39 | 42 | 81 |
| 2021 January | 33 | 20 | 53 |
| 2020 December | 31 | 15 | 46 |
| 2020 November | 28 | 18 | 46 |
| 2020 October | 25 | 18 | 43 |
| 2020 September | 34 | 22 | 56 |
| 2020 August | 40 | 14 | 54 |
| 2020 July | 29 | 15 | 44 |
| 2020 June | 26 | 24 | 50 |
| 2020 May | 23 | 13 | 36 |
| 2020 April | 29 | 16 | 45 |
| 2020 March | 32 | 13 | 45 |
| 2020 February | 45 | 17 | 62 |
| 2020 January | 41 | 13 | 54 |
| 2019 December | 46 | 19 | 65 |
| 2019 November | 52 | 19 | 71 |
| 2019 October | 30 | 14 | 44 |
| 2019 September | 37 | 19 | 56 |
| 2019 August | 39 | 15 | 54 |
| 2019 July | 26 | 22 | 48 |
| 2019 June | 53 | 19 | 72 |
| 2019 May | 29 | 10 | 39 |
| 2019 April | 64 | 24 | 88 |
| 2019 March | 37 | 17 | 54 |
| 2019 February | 25 | 15 | 40 |
| 2019 January | 27 | 13 | 40 |
| 2018 December | 118 | 34 | 152 |
| 2018 November | 220 | 17 | 237 |
| 2018 October | 243 | 16 | 259 |
| 2018 September | 122 | 14 | 136 |
| 2018 August | 62 | 22 | 84 |
| 2018 July | 82 | 16 | 98 |
| 2018 June | 112 | 15 | 127 |
| 2018 May | 106 | 18 | 124 |
| 2018 April | 172 | 16 | 188 |
| 2018 March | 156 | 5 | 161 |
| 2018 February | 184 | 7 | 191 |
| 2018 January | 104 | 7 | 111 |
| 2017 December | 113 | 5 | 118 |
| 2017 November | 72 | 11 | 83 |
| 2017 October | 30 | 8 | 38 |
| 2017 September | 44 | 8 | 52 |
| 2017 August | 42 | 9 | 51 |
| 2017 July | 49 | 9 | 58 |
| 2017 June | 35 | 9 | 44 |
| 2017 May | 35 | 10 | 45 |
| 2017 April | 36 | 7 | 43 |
| 2017 March | 24 | 8 | 32 |
| 2017 February | 26 | 6 | 32 |
| 2017 January | 14 | 5 | 19 |
| 2016 December | 32 | 5 | 37 |
| 2016 November | 19 | 7 | 26 |
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