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A Case Of Sudden Onset Laryngeal Edema And Esophageal Venous Congestion After Hemodialysis Access Creation With Same-side Jugular Tunneled Venous Line Requiring Emergent Intubation
Lindsey M. Korepta, MD.
Medical University of South Carolina, Charleston, SC, USA.
Introduction and Objectives:
Superior Vena Cava Syndrome is an uncommon condition presenting with head and neck swelling. Unilateral extremity swelling can be seen with end stage renal disease (ESRD) patients following arteriovenous (AV) access creation with central venous stenosis. There have been no reports of laryngeal edema associated with these conditions.Methods: 74 year-old female patient with ESRD on hemodialysis via tunneled right inferior jugular (IJ) central venous catheter. She underwent right brachiobasilic AV fistula creation with subsequent failure to mature and thrombosis. She then underwent right brachial to axillary AV graft creation 6 months later. Post-operative day three she developed sudden on right face and neck swelling with hoarse voice prompting a transfer to the ICU where she underwent prophylactic intubation and endoscopy. She was found to have significant laryngeal edema with dilated esophageal varices visible under her tongue and hard palate (Image 1). She was taken for emergent removal of her right IJ catheter and placement of temporary femoral venous line. She had complete resolution of her esophageal varices and head/neck edema and was extubated the same day. Results: We were able to salvage her right arm AVG access by converting her tunneled neck central venous line to femoral access. The patient was able to eventually dialyze via right arm graft and underwent removal of her tunneled femoral access with no recurrent symptoms.Conclusion: Laryngeal edema and esophageal varices are an uncommon presentation of central venous stenosis associated with hemodialysis access creation but can be treated with preservation of access.
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