Late stenosis of the subclavian vein after hemodialysis catheter injury.

In the past several years subclavian vein (SCV) access for temporary hemodialysis has achieved widespread popularity. Two cases of SCV stenosis after cannulation with hemodialysis catheters (HCs) are reported. Incapacitating edema of the upper extremity developed only after subsequent establishment of ipsilateral arteriovenous (AV) fistulas. A literature review revealed eight similar cases. Cases are typical in the development of severe upper extremity edema 2 weeks to 25 months after establishment of AV fistulas and in the site of the stenosis that is near the junction of the SCV and internal jugular vein. It is evident from reported studies of asymptomatic patients that SCV stenosis or thrombosis is a common sequel to cannulation of the SCV with HCs. Awareness of potential delayed stenosis is critical in planning vascular access procedures. Recognition of this complication enables intervention that may preserve the fistula. Balloon dilatation was performed on our patients with initial success followed by restenosis in one patient.