Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Nephrology, Union Jiangbei Hospital of Huazhong University of Science and Technology (Wuhan Caidian District People's Hospital), Wuhan, Hubei Province, China.
J Vasc Access. 2024 Jul;25(4):1355-1359. doi: 10.1177/11297298231191608. Epub 2023 Aug 5.
A 66-year-old male patient receiving maintenance hemodialysis with arteriovenous fistula of the right upper limb was admitted to the hospital because of intermittent syncope, dizziness, and distension. Central venography indicated occlusion of the right brachiocephalic vein (RBV), and the contrast agent flowed from the right internal jugular vein into the intracranial vein, then into the contralateral internal jugular vein, and finally returned into the superior vena cava. Percutaneous transluminal angioplasty was performed to dilate the RBV. Postoperatively, the contrast agent flowed smoothly into the right atrium through the RBV and the superior vena cava. Craniocerebral magnetic resonance angiography and magnetic resonance venography indicated that the intracranial venous reflux disappeared. The patient did not experience syncope again; moreover, dizziness and distention improved, as well as right facial swelling and right eye congestion, and he was discharged 2 days later. Two months later, the patient complained of dizziness. Venography under digital subtraction angiography showed severe stenosis at the RBV and percutaneous transluminal angioplasty was performed; moreover, stent placement was performed. The contrast agent flowed smoothly into the right atrium through the RBV and the superior vena cava again. Ultimately, the headaches and dizziness improved significantly postoperatively. Hence, if hemodialysis patients present with neurological symptoms, intracranial venous congestion should be monitored; nonetheless, most patients have a good prognosis when treated appropriately.
一位 66 岁男性患者，因间歇性晕厥、头晕和腹胀，在接受维持性血液透析并使用右上臂动静脉瘘时入院。中心静脉造影显示右头臂静脉（RBV）闭塞，造影剂从右侧颈内静脉流入颅内静脉，然后流入对侧颈内静脉，最后回流至上腔静脉。对 RBV 进行了经皮腔内血管成形术以扩张。术后，造影剂通过 RBV 和上腔静脉顺利流入右心房。颅脑血管磁共振血管造影和磁共振静脉造影显示颅内静脉反流消失。患者未再次出现晕厥；此外，头晕和腹胀改善，右面部肿胀和右眼充血也得到改善，2 天后出院。两个月后，患者主诉头晕。数字减影血管造影下静脉造影显示 RBV 严重狭窄，再次进行经皮腔内血管成形术，并进行支架置入术。造影剂再次通过 RBV 和上腔静脉顺利流入右心房。最终，术后头痛和头晕明显改善。因此，如果血液透析患者出现神经系统症状，应监测颅内静脉充血；然而，大多数患者在适当治疗后预后良好。
