Left Subclavian Vein Stenosis Secondary to Central Venous Access Placement: A Case Report

TL;DR

A 69-year-old patient developed left subclavian vein stenosis after central vascular access and was successfully treated with endovascular therapy and apixaban.

Contribution

Demonstrates successful endovascular treatment and apixaban monotherapy for central venous stenosis in a non-hemodialysis patient.

Findings

Endovascular treatment improved symptoms of left upper extremity edema and pain.

Follow-up over six months showed sustained improvement with monthly phlebography control.

Apixaban monotherapy was effective in managing thrombophilia-related venous stenosis.

Abstract

Venous stenosis secondary to central venous access is a well-recognized complication. However, in patients without kidney disease or those not undergoing hemodialysis, central venous stenosis is less frequently reported, suggesting that while the condition is documented in these specific populations, it may be underreported in the general population with other characteristics.

This study describes a 69-year-old patient with a history of thrombophilia due to MTHRF 677 gene heterozygous mutation, who developed left subclavian vein stenosis two weeks after the use of central vascular access, leading to left upper extremity edema, development of collateral venous network, and pain and dyspnea. Endovascular treatment was performed with recanalization and angioplasty of the subclavian vein, with favorable outcomes, improving symptoms in the immediate post-operative period and continuing through six-month follow-up with monthly consultation and phlebography control. The adequate response to this type of clinical situation with endovascular management and monotherapy with anticoagulant factor Xa inhibitor (apixaban) confirms this approach as another alternative within the field of vascular surgery.

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