Angiotomographically-proven left innominate vein occlusion in dialysis patients with prior left internal jugular vein catheterization presenting with arm swelling after ipsilateral access creation: report of four cases.

Central vein occlusion (CVO) is not uncommonly observed after hemodialysis (HD) catheter placement and it may prevent subsequent ipsilateral arteriovenous (AV) access creation. Right internal jugular vein catheterization (RJVC) appears to be the insertion site with the lowest incidence of CVO, but little is known about the incidence of CVO following left internal jugular vein catheterization (LJVC). We report on four patients with left innominate vein occlusion after LJVC who developed severe arm swelling after ipsilateral AV access creation. In three of the four cases swelling appeared 12-26 months after access creation, and in the fourth, swelling developed immediately after surgery while the catheter was still in place. Two patients underwent access ligation and in the remainder the arm swelling improved either spontaneously or after LJVC removal. LJVC is not as safe as RJVC as an insertion route for HD catheter placement in terms of CVO frequency.