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Subclavian Catheter Central Stenosis Consequence — ESENeph MCQ

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ModerateHaemodialysisSubclavian Catheter Central Stenosis ConsequenceESENeph

A 67-year-old man on haemodialysis develops a swollen, tender left AV fistula arm with pitting oedema extending to the shoulder. The fistula has no thrill or bruit. Doppler ultrasound confirms fistula thrombosis and subclavian vein occlusion. He had a previous left subclavian catheter 3 years ago. What is the MOST likely cause of the subclavian occlusion?

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Correct answer: D — Previous subclavian catheter-induced central venous stenosis

Previous subclavian vein catheterisation is the most common cause of ipsilateral central venous stenosis/occlusion. This is why subclavian catheters are strongly contraindicated for dialysis vascular access — they cause central stenosis in up to 40-50% of cases, compared to <10% for internal jugular catheters. The stenosis may be asymptomatic until an ipsilateral AV fistula increases venous flow, unmasking the obstruction and causing dramatic arm/facial swelling. This patient's central stenosis from the prior subclavian catheter has now been compounded by fistula thrombosis. This case illustrates why UKKA and KDIGO guidelines mandate preferential use of internal jugular veins and complete avoidance of subclavian catheters.

Reference: UKKA 2020 – Vascular Access; KDIGO 2019 – Vascular Access; Cimochowski et al 1990 – Subclavian Stenosis