Downhill Varices Secondary to HeRO Graft-Related SVC Syndrome
Version of Record online: 3 APR 2013
© 2013 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 26, Issue 5, pages E47–E49, September–October 2013
How to Cite
Pillai, U., Roopkiranjot, K., Lakshminarayan, N., Balabhadrapatruni, K., Gebregeorgis, W. and Kissner, P. (2013), Downhill Varices Secondary to HeRO Graft-Related SVC Syndrome. Seminars in Dialysis, 26: E47–E49. doi: 10.1111/sdi.12078
- Issue online: 16 SEP 2013
- Version of Record online: 3 APR 2013
Tunneled hemodialysis catheters are well-documented causes of benign central vein stenosis, which can be associated with proximal or downhill esophageal varices due to shunting of blood flow from the upper portion of the body through the esophageal venous plexuses. A majority of these cases remain asymptomatic. As a result, studies are largely limited to symptomatic patients, with incidence rates ranging from 16% to 29%. Recently, Hemodialysis Reliable Outflow (HeRO) graft has been introduced as an effective alternate hemodialysis access in catheter-dependent patients, especially in the presence of significant central venous occlusion. It differs from a conventional arteriovenous graft (AVG) by the fact that its venous outflow end is in the right atrium via one of the central veins, bypassing any significant occlusion upstream. Lower intervention rates and reduced incidence of bacteremia make it comparable to conventional tunneled catheters. However, the incidence of central vein occlusion and associated complications with HeRO grafts is unknown. We present the first case of gastrointestinal bleeding from downhill esophageal varices secondary to HeRO – graft-related SVC occlusion.