Catheter-related obstruction of the right brachiocephalic vein following hemodialysis in a patient with lupus nephritis.

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.