CT demonstration of dilated thoracoabdominal veins in patients with arteriovenous fistulas or grafts for hemodialysis

Purpose: The purpose of this article was to describe the CT finding of dilated thoracoabdominal veins in patients with renal failure who have arteriovenous fistulas or grafts (AVF/G) for hemodialysis. Materials and Methods: The authors retrospectively identified nine women and nine men on hemodialysis with a mean age of 62 (range, 20-88) years. Inclusion criteria for the series were functioning AVF/G, imaging with chest or abdominal CT, and access to clinical charts. Each clinical chart was evaluated for AVF/G function, diagnosis of cirrhosis or central venous obstruction, hepatitis B and C serology, and liver function as reflected by serum SGOT/SGPT. Each CT was reviewed for evidence of cirrhosis as follows: nodular liver contour, prominent left and caudate lobes, splenomegaly, and ascites. The CT scans were also evaluated for the presence of dilated thoracic or abdominal veins. The contrast-enhanced scans were evaluated for obstruction of the visualized central veins. Results: Fifty percent (9 of 18) of patients had dilated thoracoabdominal veins involving the following sites: chest wall, internal mammary, inferior phrenic, left gastric, gastric, portal, periportal, preaortic, mesenteric, splenorenal, periumbilical, and omental. None of these patients had clinical or CT evidence of cirrhosis. Eighty-nine percent (eight of nine patients) had normal serum SGOT/SGPT. Hepatitis B serology was normal in all seven patients tested, and hepatitis C serology was normal in 86% (six of seven patients). Eighty-nine percent (eight of nine patients) had no clinical or CT evidence of central venous obstruction. Among the nine patients without dilated veins, none had the clinical diagnosis of cirrhosis, although 56% (five of nine) had one or more CT findings associated with cirrhosis. None was diagnosed with central venous obstruction. Sixty-seven percent (six of nine patients) of those tested had normal serum SGOT/SGPT. Hepatitis B serology was normal in 88% (seven of eight) and 63% (five of eight) of patients tested, respectively. The authors did not find statistically significant differences between the patients with and without dilated veins with respect to the above parameters. Conclusion: Dilated thoracoabdominal veins were present in 50% of patients on hemodialysis with functioning AVF/G in this series. The venous dilatation appears to be independent of cirrhosis and central venous obstruction and is likely related to complex physiologic changes that are known to occur in patients on hemodialysis with functioning AVF/G.