Advanced Practice: Thoracic Central Venous Obstruction!

Thoracic Central Venous Obstruction: Stenosis , obstruction, compression, or occlusion of the central chest veins (subclavian, brachiocephalic, SVC)

Etiology in Dialysis Patients

  • Repeated venous trauma from central venous catheter placement
  • Repeated microtrauma from central venous catheter tips against the vessel wall (with breathing, movement)
  • High/turbulent flow from dialysis catheters or same-side fistula

Clinical Presentation

  • Ipsilateral arm/neck/face swelling


  • CT venography or standard venography (usually via access at the fistula)
  • Ultrasonagraphy of the affected extremity may fail to detect


Red circle denotes area of stenosis/occlusion in L brachiocephalic vein



  • Balloon venoplasty by interventional radiology
  • Mechanical stenting




G Collin, R.G. Jones, A.P Willis. Central Venous Obstruction in the Thorax. Clinical Radiology 2015;70(6): 654-660.