Mapping of central veins in hemodialysis patients with failed vascular access using noncontrast magnetic resonance venography

Abstract

Background Central venous stenosis is a common problem encountered in hemodialysis (HD) patients, especially those with a history of repeated central venous catheter insertions. Central venous stenosis decreases the efficiency of dialysis by the arteriovenous fistula owing to the high recirculation rates. Moreover, it reduces the potential of the creation of new vascular access. The study aimed to determine the role of noncontrast magnetic resonance venography (MRV) in the detection of stenosed or occluded intrathoracic central veins in HD patients with failed vascular access. Patients and methods The study was conducted on 16 end-stage kidney disease patients on maintenance HD. All candidates were subjected to detailed history taking, focusing on vascular access and full physical examination. Noncontrast MRV for central veins in the neck and chest was done using 1.5 T closed MRI. Results Findings detected by the noncontrast MRV included occlusion of the right internal jugular vein in 37.5% of patients, as well as occlusion of the left internal jugular vein in 37.5% of patients. An occluded left brachiocephalic vein was detected in 25% of the patients. Partial thrombosis of the superior vena cava was detected in 12.5% of patients. Four (25%) of the studied patients had occlusion or stenosis in five different veins simultaneously. Conclusions Implementation of noncontrast MRV as a screening method to guide the choice of sites of catheterization or arteriovenous fistula limb, can improve longevity and function of vascular access in HD patients.