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Venous Outflow Stenosis Limb Swelling — ESENeph MCQ

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ModerateHaemodialysisVenous Outflow Stenosis Limb SwellingESENeph

A 38-year-old man on haemodialysis via a left radiocephalic arteriovenous fistula develops progressive swelling of his left hand and forearm. The fistula has good thrill and bruit. There is no erythema or tenderness. Venous distension is visible on the dorsum of the hand and forearm. What is the most likely diagnosis?

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Correct answer: C — Venous outflow stenosis causing venous hypertension

Progressive hand and forearm swelling with preserved fistula function (good thrill/bruit), visible venous distension, and absence of infection signs is characteristic of venous outflow stenosis causing venous hypertension. This occurs when there is a stenosis downstream of the anastomosis (often at the cephalic arch or central veins), causing elevated venous pressure with resultant limb oedema and superficial venous distension. Steal syndrome presents with ischaemic symptoms (pain, pallor, coolness). DVT would cause tenderness. Fistula thrombosis would abolish the thrill/bruit.

Reference: UKKA 2020 – Vascular Access Guidelines; ESVS 2018 – Vascular Access Guidelines