Main Article Content
Objective: The aims of this study were to describe direct computed tomography venography (CTV) for upper limb venous system evaluation and to report on findings in end-stage renal disease (ESRD) patients.
Materials and Methods: Direct CTV was performed using a 64-multidetector computed tomography (MDCT) scanner with simultaneous injection of diluted iodinated contrast (IC); 1:4 at both elbows and 2-phase scanning namely, the direct venous, and the arterial phases. The findings in ESRD patients evaluated between November 2013 and March 2019 were retrospectively reviewed.
Results: Forty CTV examinations (600 venous segments) were performed and the volume of IC used per patient was 38 mL. Number of lesions found in a patient ranged from 1 to 6 and the majority had 1 to 3 lesions (30/38 patients). Stenosis and thrombosis were the two most common findings (112/600) and were equally prevalent. The three most common sites of steno-occlusive complications were the brachiocephalic vein (29 lesions), the internal jugular vein (25 lesions), and the subclavian vein (16 lesions). The most common site of stenosis was the brachiocephalic vein (18 lesions), whereas the most common site of thrombosis was the internal jugular vein (20 lesions). No venous aneurysms or ruptures were found. IC extravasation at the site of injection occurred in one arm in one patient.
Conclusion: Direct CTV has the advantage of requiring lower IC volume while maintaining direct visualization of the venous system similar to conventional venography.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles published in the Siriraj Medical Journal (SMJ) are protected by copyright. No material in this journal may be reproduced on any platform including electronic or in print or transmitted by any means, in whole or in part, without the prior written permission of the Editor of the SMJ. Written permission must also be obtained before any part of the SMJ is stored in any retrieval system of any nature.
2. Tanju S, Sancak T, Dusunceli E, Yagmurlu B, Erden I, Sanlidilek U, et al. Direct contrast-enhanced 3D MR venography evaluation of upper extremity deep venous system. Diag Interv Radiol 2006;12:74-79.
3. Li B, Li Q, Chen C, Guan Y, Liu S. Diagnostic accuracy of computed tomography angiography and magnetic resonance angiography in the stenosis detection of autologous hemodialysis access: a meta-analysis. PLoS One 2013;8:e78409.
4. Karadeli E, Tarhan NC, Ulu EM, Tutar NU, Basaran O, Coskun M, et al. Evaluation of failing hemodialysis fistulas with multidetector CT angiography: comparison of different 3D planes. Eur J Radiol 2009;69:184-92.
5. Cavagna E, D'Andrea P, Schiavon F, Tarroni G. Failing hemodialysis arteriovenous fistula and percutaneous treatment: imaging with CT, MRI and digital subtraction angiography. Cardiovasc Intervent Radiol 2000;23:262-5.
6. Ghaye B, Dondelinger RF. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis. Eur Radiol 2002;12:1906-21.
7. Zhou PL, Wu G, Han XW, Bi YH, Zhang WG, Wu ZY. Detection and characterization of Budd-Chiari syndrome with inferior vena cava obstruction: comparison of fixed and flexible delayed scan time of computed venography. Eur J Radiol 2017;91:52-56.
8. Mavili E, Ozturk M, Akcali Y, Donmez H, Yikilmaz A, Tokmak TT, et al. Direct CT venography for evaluation of the lower extremity venous anomalies of Klippel-Trenaunay syndrome. AJR Am J Roentgenol 2009;192:W311-6.
9. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2006. Am J Kidney Dis 2006;48(Suppl):S176-247.
10. Kassem TW. Upper limb DVT after hemodialysis AVF creation: role of CT venography. Egyptian J Radiol Nuclear Med 2016;47:897-902.
11. Svensson A, Brismer TB, Brehmer K. Computed tomography venography of the upper extremities-using low dose bilateral contrast media injection in a patient with suspected venous thoracic outlet syndrome. Radiol Case Rep 2020;15:302-5.
12. Kuo YS, Chen CJ, Chen JJ, Lin CH, Ku JW, Hsu HL, et al. Mey-Thurner syndrome: correlation between digital subtraction and computed tomography venography. J Formos Med Assoc 2015;114:363-8.
13. Sullivan KL, Bonn J, Shapiro MJ, Gardiner GA. Venography with carbon dioxide as contrast agent. Cardiovas Intervent Radiol 1995;18:141-5.
14. Geoffroy O, Tassart M, Le Blanche AF, Khanlil A, Duedal Z, Rossert J, et al. Upper extremity digital subtraction venography with gadoterate meglumine before fistula creation for hemodialysis. Kidney Int 2001;59:1491-7.
15. Yamashita R, Isoda H, Arizono S, Ono A, Onishi N, Furuta A, et al. Non contrast enhanced magnetic resonance venography using magnetization-prepared rapid gradient-echo (MPRAGE) in the preoperative evaluation of living donor candidates: comparison with conventional computed tomography venography. Eur J Radiol 2017;90:89-96.
16. Gao L, Xu W, Li T, Yu X, Cao S, Xu H, et al. Accuracy of magnetic resonance venography in diagnosing cerebral venous sinus thrombosis. Thromb Res 2018;167:64-73.
17. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol 2006;1:332-9.
18. Dumars MC, Thompson WE, Bluth EI, Lindberg JS, Yoselevitz M, Merritt CR. Management of suspected hemodialysis graft dysfunction: usefulness of diagnostic US. Radiology 2002;222:103-7.
19. Rooijens PP, Tordor JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004;28:583-9.
20. Padberg Jr FT, Calligaro KD, Sidawy AN, Sidawy S. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008;48:55S-80S.
21. Ocak G, Rotmans JI, Vossen CY, Rosendaal FR, Krediet RT, Boeschoten EW, et al. Type of arteriovenous vascular access and association with patency and mortality. BMC Nephrol 2013;14:79.
22. Margey R, Schainfeld RM. Upper extremity deep vein thrombosis: the oft-forgotten cousin of venous thromboembolic disease. Curr Treat Options Cardiovasc Med 2011;13:146-58.
23. Jamshid R, Reza SA, Abbas G, Raha A. Incidence of arteriovenous thrombosis and the role of anticardiolipin antibodies in hemodialysis patients. Int Urol Nephrol 2003;35:275-82.
24. Murphy EA, Ross RA, Jones RG, Gandy SJ, Aristokleous N, Salsano M, et al. Imaging in vascular access. Cardiovasc Eng Technol 2017;8:255-72.
25. Preston DL, Ron E, Tokuoka S, Nishi FN, Soda M, Mabuchi K, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 2007;168:1-64.