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Central Venous Stenosis — ESENeph MCQ

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ModerateHaemodialysisCentral Venous StenosisESENeph

A 70-year-old man with a native AV fistula for haemodialysis develops a swollen arm with visible collateral veins on the chest wall. Dialysis pressures are elevated. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Central venous stenosis

Arm swelling with chest wall collateral veins in a dialysis patient with an AV fistula suggests central venous stenosis (subclavian or brachiocephalic vein). This is particularly common in patients with prior central venous catheter placement. Elevated venous pressures during dialysis are characteristic. Diagnosis is confirmed by fistulography or venography. Treatment is usually endovascular angioplasty with or without stenting. UKKA vascular access guidelines recommend avoiding subclavian catheters to prevent this complication.

Reference: UK Kidney Association 2019 – Vascular Access Guideline