Pleural effusion with arm, breast, and face edema as a complication of subclavian vein catheterization and arteriovenous fistula in a patient after renal transplantation: A therapeutic approach

A 52-year-old woman after renal transplantation developed unilateral pleural effusion as well as a massive edema of the upper limb, breast, and face as a complication of the subclavian vein catheterization and arteriovenous fistula for hemodialysis. We revealed that impaired venous drainage due to extensive vein occlusion after temporary catheter insertion, together with high venous flow from the arteriovenous fistula, were the explanation. Because of moderately impaired renal graft function and limited availability of vascular access in the patient, fistula ligation as a therapeutic method described in literature, was not an option in our case. The patient underwent an unsuccessful attempt of venous angioplasty, and eventually banding of the fistula and blood flow reduction resolved pleural effusions and edema. This is a reasonable approach to the problem of massive upper torso edema due to central vein occlusion with ipsilateral arteriovenous fistula.

Keywords: Pleural effusion; arteriovenous fistula; dilator-assisted fistula banding; renal transplantation; subclavian vein catheterization; upper limb edema.