Upper Limb Edema - A Single Centre Experience - Dr. Venkatesh Rajkumar

1. Upper limb edema in hemodialysis patientsUpper limb edema in hemodialysis patients
A single centre experienceA single centre experience
Venkatesh Rajkumar
Apollo speciality hospitals, Chennai
•Upper limb edema is a common problem in long
term hemodialysis patients
•The most common etiology is venous
hypertension
•The site of venous obstruction varies from venous
outflow tract to central veins
•To evaluate the etiology of upper limb edema
•To assess the effectiveness of endovascular
interventions in venous edema
• Prospective analysis (Jan 2015- Jun 2016)
• All patients presenting to our dialysis unit with
isolated upper extremity swelling were included
• A fistulogram was performed
Total number of patients included n=10
ETIOLOGY OF EDEMA:
•Central venous stenosis(CVS) : 7
( all left brachiocephalic)
•Venous outflow tract obstruction :2
( both were at graft vein anastomosis)
•Other causes :1 ( Venous HT due to side
to side Brachio basilic fistula)
PROCEDURES DONE:
• Central vein stenosis is the commonest
cause of venous edema (70%) followed by
venous outflow obstruction (20%).
• All the patients with central stenosis had
previous history of temporary jugular
catheter insertions.
• Both the cases of graft vein anastamotic
stenosis responded completely to PTA and
are still on follow up.
• Four out of six cases of central stenosis
responded completely. Two had a partial
recanalization with partial resolution of
edema.
• AV fistula could be used successfully in all
of the patients post angioplasty.
• Complications were mainly in the form of
small hematomas (grade 1) in two patients
Aim
Introduction
METHODS
RESULTS
Patients presenting with edema
(N =16)
AV Graft : 2
Brachio Axillary
AV fistula : 8
Left Radio cephalic: 6
Left Ulnar basilic: 1
Left Brachio Basilic: 1
DISCUSSION
CONCLUSION
Venous stenosis presenting as upper limb edema
could be effectively managed by percutaneous
angioplasties on them with a very high technical
and clinical success rate and with an acceptable
rate of complications
ACKNOWLEDGEMENT:
I hereby thank the Indian society of
Nephrology and the International society of
Nephrology for having helped me enter the
field of Interventional Nephrology
Not willing
for the
procedure: 6
Patients who
underwent
fistulogram:10

2. Upper limb edema in hemodialysis patients
A single centre experience
Venkatesh Rajkumar
Apollo speciality hospitals, Chennai
LEFT BRACHIOCEPHALIC STENOSIS
ATLAS 14mm
Balloon
GRAFT VEIN ANASTAMOTIC STENOSIS: RT
BRACHIO AXILLARY GRAFT
MUSTANG
8mm Balloon