The double trouble: A case report on central vein dual stenosis

Central vein stenosis is a common complication in patients with chronic kidney disease undergoing regular hemodialysis. Prolonged use of central venous catheters and repeated punctures can lead to fibrosis and scarring, resulting in stenosis. Computed tomography angiography (CTA), ultrasonography, and conventional venography are essential diagnostic tools for thoroughly evaluating central vein stenosis. A 75-year-old male patient with a history of chronic kidney disease on regular hemodialysis who had undergone percutaneous transluminal angioplasty (PTA) of the left subclavian vein one month prior was referred to our institution with swelling of the left arm. Preprocedural computed tomography angiography (CTA) was not performed due to financial constraints, and the evaluation relied solely on ultrasonography. Initial venographic assessment revealed restenosis at the previously treated site, prompting a repeat PTA. Although the stenosis was successfully resolved, subsequent venographic evaluation identified an additional stenotic lesion proximal to the treated site, which was not adequately accessed via the cephalic catheter. A second PTA was performed via the femoral approach, confirming successful dilation of the secondary lesion. The absence of preprocedural CTA posed a significant challenge in accurately delineating the full extent of venous pathology. While ultrasonography remains a valuable tool, it has notable limitations in detecting stenoses located in less accessible anatomical regions. Therefore, preprocedural CTA remains essential for comprehensive assessment and treatment planning in cases of central vein stenosis requiring PTA.