Variceal Hemorrhage as Complication of Vascular Access for Total Parenteral Nutrition

Downhill varices, a rare manifestation of venous hypertension, arise from superior vena cava (SVC) obstruction. We present a unique case of downhill varices secondary to SVC syndrome in a 69-year-old man on chronic total parenteral nutrition who presented with large volume melena and facial swelling. In this case, chronic central venous catheter use contributed to thrombotic occlusion of the SVC, leading to collateral vessel formation and variceal development. Management involves addressing the underlying cause of venous obstruction. This case highlights the importance of considering downhill varices as a complication in patients with chronic vascular access presenting with symptoms of SVC syndrome.