END-STAGE RENAL-DISEASE WITH VENOUS OCCLUSION IN BOTH UPPER EXTREMITIES

We studied 27 patients with venographically documented bilateral subcl avian vein occlusion thrombosis after the use of dual lumen hemodialys is catheters. Immediate venous access was severely limited because all patients had previously had multiple access failures. The rate of ven ous pressure rise between hemodialysis treatments is in consistent in suggesting imminent thrombosis as the sole explanation of venous throm bosis, yet it is a signal to investigate vein patency. Venography may be the best method, pending further development of duplex ultrasonogra phy. The lack of clinical symptoms warrants early use of duplex ultras onography and venography to document subclavian vein occlusion thrombo sis so that heparin and thrombolytic therapy may be initiated. Length of time between onset of pressure increase and initiation of therapy d id not affect successful outcome.