Digital Subtraction Venography Diagnostic for Suspected Venous Obstruction after A-V Shunt

Aims: To determine the diagnostic function of digital subtraction venography (DSV) in suspected venous hypertension after the A-V Shunt procedure.

Presentation of case: Four patients were admitted to the hospital with swelling from the hand up to the shoulder and pain in the upper limb. All patients suffered from chronic renal failure and underwent hemodialysis. The assessment was suspect venous hypertension, and each of them underwent DSV examination procedure as diagnostic support. DSV examinations showed partial obstruction of 1/3 left media subclavian vein in the first patient, partial obstruction of 1/3 left media subclavian vein in the second patient, total obstruction innominate vein in the third patient, and total obstruction of 1/3 right media subclavian vein in the fourth patient.

Discussion: The use of digital subtraction technique may simplify imaging of the venous structures of the arm and upper mediastinum, especially in patients with compromised peripheral venous access. DSV offers more advantages than conventional venography and was recommended as diagnostic procedure for venous hypertension.

Conclusion: DSV is the gold standard for the diagnosis of central venous stenosis and obstruction; it is accurate and safe to use to diagnose venous hypertension disease. DSV can also be used to determine the next treatment.