Steele Lloyd, Flowers David, Coles Simon, Gibbs Paul
Imperial College Healthcare NHS Trust, London, UK.
Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK.
BMJ Case Rep. 2019 Jul 26;12(7):e229398. doi: 10.1136/bcr-2019-229398.
A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.
一名51岁男性在因血液透析通路而进行左上臂聚四氟乙烯移植术后2周，出现左臂肿胀和单侧搏动性耳鸣。左上臂动静脉内瘘造影显示中心静脉狭窄，且有大量血液沿左颈内静脉逆向流动。经皮腔内血管成形术尝试失败，随后进行了内瘘结扎。这立即消除了耳鸣。静脉狭窄可能继发于1年前已移除的心脏再同步化治疗除颤器。中心静脉狭窄是心脏装置常见但通常无症状的并发症，不过上肢动静脉内瘘患者除外，这类患者常出现有症状的静脉高压。这通常表现为同侧手臂肿胀和/或透析期间静脉压力升高。据我们所知，这是在此种情况下出现搏动性耳鸣的首例报告。
