Early Identification and Early Intervention for Better Result Transluminal Angioplasty in Hemodialysis Patient

Abstract

BACKGROUND: Stasis, thrombosis, and impaired arteriovenous (AV) fistula are possible problems to manifest central venous stenosis (CVS). Almost 25% dysfunctional fistulas at patient with dialysis are known to have these problems. Proper and immediate identification of CVS is critical to improve the successful rate of percutaneous transluminal angioplasty (PTA) in hemodialysis patient. We present the immediate decision of CVS in hemodialysis patients. CASE PRESENTATION: This is case of a 53-year-old woman complaining of left arm swelling for 2 weeks. These complaints are not combined by pain, fever, or accidental injuries to the arm. She routinely undergoes hemodialysis (HD) twice a week with AV fistula access in the left arm for 12 years. HD can still run smoothly even with swelling in her left arm. PTA was performed without waiting HD problem as an immediate management of CVS and resulting without any complications. CONCLUSION: CVS is generally associated with long-term AV fistula. The endothelial injury from physical stimulation of the vein wall preceded the development of CVS and also developed smooth muscle proliferation and microthrombi. PTA as an immediate procedure for CVS has high rate of success although patentability is low in long-term condition. This patient is still needed to follow-up for determining long-term patency.