Recanalization of superior vena cava occlusion combined with "criminal" venous embolization for the treatment of downhill esophageal variceal bleeding in hemodialysis patient: a case report
10.3760/cma.j.cn441217-20240722-00737
- VernacularTitle:上腔静脉开通联合“罪犯”静脉栓塞治疗血液透析患者下行食管静脉曲张破裂出血1例
- Author:
Haocheng ZHU
1
;
Huihui LI
1
;
Qiquan LAI
1
;
Ziming WAN
1
Author Information
1. 重庆医科大学附属第一医院肾内科，重庆 400010
- Publication Type:Journal Article
- Keywords:
Superior vena cava syndrome;
Esophageal and gastric varices;
Cuff ligating therapy;
Venous embolization
- From:
Chinese Journal of Nephrology
2025;41(4):282-284
- CountryChina
- Language:Chinese
-
Abstract:
Downhill esophageal varices (DEV) is a rare cause of upper gastrointestinal bleeding. It is different from ascending esophageal varices caused by portal hypertension, and caused by obstruction of the superior vena cava. It can be secondary to an indwelling central venous catheter. It is very dangerous when DEV is complicated with upper gastrointestinal bleeding,and there is no unified treatment strategy at present. We report a case of hemodialysis patient with left upper limb swelling for 6 months and intermittent hematemesis for 3 months. Combined with gastroscopy and CT venography, the patient was considered to have DEV rupture and hemorrhage. The patient was discharged after comprehensive treatment including closure of internal arteriovenous fistula, ligation of bleeding points of esophageal varices, recanalization of superior vena cava, and "culprit" vein embolization. There was no recurrence after half a year of follow-up. This case is helpful for clinicians to improve the recognition on this disease and explore the experience of diagnosis and treatment.
