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Khan AA, Turki M, Frandah W. An Unusual Case of Hematemesis. Gastroenterology 2022:S0016-5085(22)01383-X. [PMID: 36502861 DOI: 10.1053/j.gastro.2022.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Adnan Aman Khan
- Section of Gastroenterology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia.
| | - M'hamed Turki
- Section of Gastroenterology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | - Wesam Frandah
- Section of Gastroenterology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
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2
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Ali H, Pamarthy R, Bolick NL, Ali E, Paleti S, Kapuria D. Downhill esophageal varices: a systematic review of the case reports. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: The etiologies, presentation, and management of downhill varices in the era of modern medicine are relatively under-explored and mostly limited to case reports or case series.
Methods: Published case reports/series of patients ≥ 18 years old with proven/probable downhill esophageal varices were searched on Ovid MEDLINE and Ovid EMBASE for all published cases up to January 2021.
Results: The mean age was 50.9 (standard deviation ± 17.6) years old for all downhill variceal cases. End-stage renal disease was the most common comorbidity (43.9%), followed by thyroid disease (12.2%), Behçet’s disease (9.8%), and pulmonary hypertension (7.3%). Dialysis catheters, central venous grafts, or additional catheters were additional risk factors (51.2%). Variceal bleeding presenting as hematemesis, melena, or both was the most common presenting symptom (80.5%).
Conclusions: Dialysis catheter-associated superior vena cava obstruction resulted in an increased risk of downhill varices. Other causes include thyroid malignancies, pulmonary hypertension, and Behçet’s disease.
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Affiliation(s)
- Hassam Ali
- 1Department of Internal Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Rahul Pamarthy
- 1Department of Internal Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Nicole Leigh Bolick
- 2Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Eslam Ali
- 3Department of Gastroenterology, East Carolina University, Greenville, NC 27834, USA
| | - Swathi Paleti
- 4Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Devika Kapuria
- 5Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO 63130, USA
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3
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Ali H, Sarfraz S, Sarfraz A. Recurrent Hematemesis From Downhill Esophageal Varices: A Therapeutic Challenge for Gastroenterologists. Cureus 2021; 13:e13840. [PMID: 33859896 PMCID: PMC8038912 DOI: 10.7759/cureus.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Downhill or upper esophageal varices have an etiology that differs from that of the “uphill” varices secondary to portal hypertension. Approximately 0.1% of all cases of variceal hemorrhage are due to downhill varices. The underlying etiology is obstruction of the superior vena cava (SVC) which results in the shunting of blood from the systemic circulation into the esophageal plexus, predominantly the upper two-thirds. The management should be directed to relieve the vascular obstruction. One of the causes of SVC obstruction leading to downhill variceal bleeding is dialysis catheter-associated SVC stenosis. We report the case of a 34-year-old male with hematemesis associated with downhill varices due to chronic SVC obstruction because of a central venous catheter.
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Affiliation(s)
- Hassam Ali
- Internal Medicine, East Carolina University, Vidant Medical Center, Greenville, USA
| | - Shiza Sarfraz
- Anesthesiology, Bahawal Victoria Hospital, Quaid-E-Azam Medical College, Bahawalpur, PAK
| | - Abeera Sarfraz
- Internal Medicine, Federal Medical and Dental College, Islamabad, PAK
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4
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Uceda PV, Peralta Rodriguez J, Vela H, Lozano Miranda A, Vega Salvatierra L, Feldtman R, Ahn SS. Management of Superior Vena Cava Occlusion Causing Bleeding "Downhill" Esophageal Varices. J Endovasc Ther 2021; 28:469-473. [PMID: 33480291 DOI: 10.1177/1526602821989330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding "downhill" esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from "downhill" esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.
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Affiliation(s)
| | | | - Hernán Vela
- Thoracic and Cardiovascular Surgery, Hospital Nacional Dos de Mayo, Lima, Peru
| | | | | | - Robert Feldtman
- DFW Vascular Group, Dallas, TX, USA.,TCU School of Medicine, Fort Worth, TX, USA
| | - Sam S Ahn
- DFW Vascular Group, Dallas, TX, USA.,TCU School of Medicine, Fort Worth, TX, USA
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5
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Gebreselassie A, Awan A, Yaqoob H, Laiyemo A. Superior Vena Cava Obstruction: A Rare Cause of Recurrent Esophageal Variceal Bleeding. Cureus 2018; 10:e2226. [PMID: 29713571 PMCID: PMC5919766 DOI: 10.7759/cureus.2226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
"Downhill" esophageal varices are formed in upper two-thirds of the esophagus as a consequence of a superior vena cava obstruction. We present a case of 55-year-old African-American female with a medical history of multiple comorbidities, including end-stage renal disease, who presented with an upper gastrointestinal bleed and was found to have distended neck veins on physical examination. She gave a history of the insertion of an intravenous central line in her neck area for hemodialysis purposes about six years previously. An endoscopy showed the presence of esophageal varices and computed tomography (CT) of the abdomen showed the presence of a superior vena cava (SVC) obstruction. The patient was managed supportively. This case represents a rare cause of acute upper gastrointestinal bleeding in an individual with a central line for dialysis leading to SVC thrombosis.
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Affiliation(s)
| | - Ahmad Awan
- Department of Internal Medicine, Howard University Hospital
| | - Hamid Yaqoob
- Department of Internal Medicine, Howard University Hospital
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6
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Downhill Esophageal Varices Associated With Central Venous Catheter-Related Thrombosis Managed With Endoscopic and Surgical Therapy. ACG Case Rep J 2016; 3:e102. [PMID: 27807564 PMCID: PMC5062659 DOI: 10.14309/crj.2016.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Downhill esophageal varices are a rare cause of upper gastrointestinal hemorrhage. We present a case of downhill variceal bleeding due to superior vena cava thrombosis resulting from a prior central venous catheter. The patient was managed with endoscopic band ligation and later with surgical axillary vein to right atrium bypass grafting. Successful long-term resolution of varices was achieved at 1 year of follow-up. This is the longest follow-up described for combined endoscopic and surgical management in the existing literature for catheter-associated downhill varices.
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7
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Loudin M, Anderson S, Schlansky B. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review. BMC Gastroenterol 2016; 16:134. [PMID: 27776486 PMCID: PMC5078907 DOI: 10.1186/s12876-016-0548-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/18/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices. Given the alternative pathophysiology of downhill varices, they require a unique approach to management. Variceal band ligation may be used to temporize acute variceal bleeding, and should be applied on the proximal end of the varix. Relief of the underlying SVC obstruction is the cornerstone of definitive treatment of downhill varices. CASE PRESENTATION A young woman with a benign superior vena cava stenosis due to a tunneled internal jugular vein dialysis catheter presented with hematemesis and melena. Urgent upper endoscopy revealed multiple 'downhill' esophageal varices with stigmata of recent hemorrhage. As there was no active bleeding, no endoscopic intervention was performed. CT angiography demonstrated stenosis of the SVC surrounding the distal tip of her indwelling hemodialysis catheter. The patient underwent balloon angioplasty of the stenotic SVC segment with resolution of her bleeding and clinical stabilization. CONCLUSION Downhill esophageal varices are a distinct entity from the more common distal esophageal varices. Endoscopic therapies have a role in temporizing active variceal bleeding, but relief of the underlying SVC obstruction is the cornerstone of treatment and should be pursued as rapidly as possible. It is unknown why benign, as opposed to malignant, causes of SVC obstruction result in bleeding from downhill varices at such a high rate, despite being a less common etiology of SVC obstruction.
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Affiliation(s)
- Michael Loudin
- Department of Medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, L-461, USA.
| | - Sharon Anderson
- Department of Medicine, Division of Nephrology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Barry Schlansky
- Department of Medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, L-461, USA
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8
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Conservative Management of Downhill Esophageal Varices Secondary to Central Line-related Thrombosis After Hematopoietic Stem Cell Transplant. J Pediatr Hematol Oncol 2015; 37:e424-6. [PMID: 26056785 DOI: 10.1097/mph.0000000000000373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Occlusive central line-related complications are not infrequent in children undergoing cancer therapy, but are generally not associated with life-threatening complications. Thrombosis of the superior vena cava (SVC) is rarely described in such patients, and downhill esophageal varices have been described in children and adults as a complication of altered SVC blood flow. The management of patients with SVC thrombosis and associated varices is complicated by the need to treat the thrombus weighed against bleeding risk. We present a 14-year-old adolescent with a history of acute leukemia and central line-related complications, including SVC thrombosis with subsequent formation of downhill esophageal varices. Conservative management consisting of anticoagulation alone resulted in resolution of the varices with no bleeding complications.
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9
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Downhill esophageal varices: a prevalent complication of superior vena cava obstruction from benign and malignant causes. J Comput Assist Tomogr 2015; 39:149-52. [PMID: 25474143 DOI: 10.1097/rct.0000000000000183] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Downhill esophageal varices (DEV) usually develop secondary to superior vena cava (SVC) obstruction. Downhill esophageal varices have been less well characterized compared to uphill varices. The aim of the study was to characterize the anatomy and etiology of DEV by contrast-enhanced computed tomography. METHODS Patients with SVC obstruction were included in the study. Downhill esophageal varices were defined as discrete esophageal submucosal or mucosal vessels. Ten random computed tomographic scans were assessed as controls. RESULTS Downhill esophageal varices were seen in 11 of 36 patients. Three types of varices were observed. Between 1 and 6 varices were seen in each patient with a diameter of 1 to 5 mm. CONCLUSIONS Downhill esophageal varices can be seen in 30% of patients with SVC obstruction. They have several patterns and are mostly systemic-to-systemic collaterals. The most common etiology associated with DEV is renal failure. Downhill esophageal varices are of small caliber, this may in part account for less frequent bleeding compared to uphill varices.
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10
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Yasar B, Abut E. A case of mediastinal fibrosis due to radiotherapy and 'downhill' esophageal varices: a rare cause of upper gastrointestinal bleeding. Clin J Gastroenterol 2015; 8:73-6. [PMID: 25708450 DOI: 10.1007/s12328-015-0555-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
'Downhill' varices are located in the proximal part of the esophagus. Their etiology differs from the distal types, with most of them usually being related to superior vena cava obstruction. Although bleeding due to 'downhill' varices is very rare, it can be life-threatening. Here, we present a case of upper gastrointestinal bleeding due to mediastinal fibrosis associated with chest radiotherapy for seminoma metastasis sixteen years previously, which was successfully treated conservatively.
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Affiliation(s)
- Bulent Yasar
- Department of Gastroenterohepatology, Camlica Erdem Hospital, Alemdag Yanyol Street, Uskudar, Istanbul, 34696, Turkey,
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11
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Ontanilla Clavijo G, Trigo Salado C, Rojas Mercedes N, Caballero Gómez JA, Rincón Gatica A, Alcívar-Vasquez JM, Márquez Galán JL. Downhill varices: an uncommon cause of upper gastrointestinal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 108:440-442. [PMID: 27643628 DOI: 10.17235/reed.2016.3697/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. CASE REPORT A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. DISCUSSION DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.
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12
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Ontanilla Clavijo G, Trigo Salado C, Marquez Galan JL. Downhill varices: An uncommon cause of upper gastrointestinal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015. [DOI: 10.17235/reed.2015.3697/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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"Downhill" Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding. Case Rep Gastrointest Med 2013; 2013:830796. [PMID: 23509642 PMCID: PMC3590564 DOI: 10.1155/2013/830796] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/20/2013] [Indexed: 12/13/2022] Open
Abstract
"Downhill" varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed "downhill" varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare "downhill" varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.
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14
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Recognition of downhill esophageal varices in hemodialysis patients requires a high index of clinical suspicion. Clin Exp Nephrol 2009; 13:677-8. [DOI: 10.1007/s10157-009-0204-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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15
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Vorlop E, Zaidman J, Moss SF. Clinical challenges and images in GI. Downhill esophageal varices secondary to superior vena cava occlusion. Gastroenterology 2008; 135:1863, 2158. [PMID: 19013160 DOI: 10.1053/j.gastro.2008.10.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Erich Vorlop
- Rhode Island Hospital, Providence, Rhode Island, USA
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16
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Therapeutic approach to "downhill" varices bleeding. Gastrointest Endosc 2008; 68:1010-2. [PMID: 18436214 DOI: 10.1016/j.gie.2008.02.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 02/18/2008] [Indexed: 02/08/2023]
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17
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Formation of downhill esophageal varices as a rare but serious complication of hemodialysis access: a case report and comprehensive literature review. Clin Exp Nephrol 2008; 12:407-415. [PMID: 18401548 DOI: 10.1007/s10157-008-0055-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Proximal or "downhill" esophageal varices are a rare complication of superior vena caval (SVC) obstruction. Few reports describe downhill varices in dialysis patients with catheter-related SVC occlusion. METHODS We studied a case of downhill esophageal varices in a dialysis patient from our center and reviewed the published literature on presentation, evaluation and treatment in other dialysis patients (MEDLINE database search). RESULTS Including our current case, we identified eight reports of dialysis patients with downhill varices. All cases were recognized after presentation with gastrointestinal bleeding, in contrast to low reported bleeding rates of downhill varices in non-dialysis patients. Localized edema and superficial venous engorgement (signs of SVC occlusion) were each observed in four of eight patients. The duration of hemodialysis dependence ranged from 2.5 to 23 years, and dialysis access history included multiple central venous catheters when described (seven cases). Central venous imaging by direct, magnetic resonance or computerized tomographic venography documented SVC stenosis in all cases. Management included percutaneous transluminal angioplasty of the SVC with or without stenting in five of eight patients, three of whom developed restenosis during observation. Successful surgical venous bypass was performed in one patient after failed percutaneous venoplasty. Varices were treated with band ligation in four of eight cases without reported complications. CONCLUSIONS Although rare, downhill esophageal varices should be considered in the differential diagnosis of upper gastrointestinal hemorrhage in dialysis patients exposed to central venous catheters. Diagnosis should prompt radiographic evaluation of SVC patency. Treatment requires timely and coordinated care by specialists in endovascular interventions and gastrointestinal endoscopy.
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18
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Tavakkoli H, Asadi M, Haghighi M, Esmaeili A. Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report. BMC Gastroenterol 2006; 6:43. [PMID: 17192182 PMCID: PMC1769384 DOI: 10.1186/1471-230x-6-43] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 12/27/2006] [Indexed: 01/11/2023] Open
Abstract
Background One of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV) and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time. Case presentation We report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur. Conclusion Band ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.
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Affiliation(s)
- Hamid Tavakkoli
- Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Asadi
- Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahshid Haghighi
- Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Chandra A, Tso R, Cynamon J, Miller G. Massive upper GI bleeding in a long-term hemodialysis patient. Chest 2005; 128:1868-9, 1870-73. [PMID: 16162797 DOI: 10.1378/chest.128.3.1868] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alpana Chandra
- Department of Medicine, Montefiore Medical Center, Goldzone Main Floor, 111 E 210th St, Bronx, NY 10467, USA.
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20
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Hsu YH, Yang MT, Hsia CC, Tsai DM. Esophageal varices as a rare complication of central venous dialysis tunneled cuffed catheter. Am J Kidney Dis 2004; 43:e20-4. [PMID: 14750121 DOI: 10.1053/j.ajkd.2003.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Long-term complications of tunneled cuffed catheters include infection and catheter and venous thrombosis. We present a case of a central venous dialysis tunneled cuffed catheter complicated with esophageal varices resulting from superior vena cava obstruction.
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Affiliation(s)
- Yung-Hsuen Hsu
- Department of Nephrology, Taipei Municipal Jen Ai Hospital, Taipei, Taiwan, ROC
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21
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Savoy AD, Wolfsen HC, Paz-Fumagalli R, Raimondo M. Endoscopic therapy for bleeding proximal esophageal varices: a case report. Gastrointest Endosc 2004; 59:310-3. [PMID: 14745415 DOI: 10.1016/s0016-5107(03)02548-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alan Drew Savoy
- Department of Radiology, Mayo Clinic, Jacksonville, Florida 32224, USA
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22
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Yarze JC. "Downhill" esophageal varices. Am J Gastroenterol 2002; 97:1841-2; author reply 1842. [PMID: 12135050 DOI: 10.1111/j.1572-0241.2002.05861.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Abstract
Percutaneous placement of cuffed tunneled catheters for hemodialysis access has become a firmly established method of providing vascular access to patients with end-stage renal disease. Considerable evidence supports the right internal jugular vein as the preferred site for catheter insertion. The use of real-time imaging using both ultrasound and fluoroscopy permits simple, safe, and effective placement of the catheter for hemodialysis. The use of these imaging techniques has significantly reduced the number of and severity of complications associated with catheter placement. A specific method of placement is described including variations for specific catheter types. The new subcutaneous port as an alternative to the cuffed tunneled catheter appears to provide another option for vascular access; preliminary data suggests higher flow rates and lower infection rates compared with externalized cuffed tunneled catheters. Finally, the criteria for obtaining training and proficiency in placement of cuffed tunneled catheters are outlined.
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Affiliation(s)
- Jack Work
- Renal Division, Emory University, Atlanta, GA 30322, USA.
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24
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Blam ME, Kobrin S, Siegelman ES, Scotiniotis IA. "Downhill" esophageal varices as an iatrogenic complication of upper extremity hemodialysis access. Am J Gastroenterol 2002; 97:216-8. [PMID: 11808963 DOI: 10.1111/j.1572-0241.2002.05417.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Abstract
Since the 1997 publication of the Disease Outcomes Quality Initiative (DOQI) vascular access guidelines for cuffed, tunneled catheter placement, additional evidence supporting these recommendations has been published, including additional documentation supporting the right internal jugular vein as the preferred site for insertion. Placing the catheter tip in the right atrium rather than in the superior vena cava will provide adequate blood flow to support effective hemodialysis. The right atrial positioning of the catheter tip will also accommodate catheter tip retraction and decrease the likelihood of malfunction. Overwhelming evidence now supports the use of ultrasound guidance to assist cannulation of the internal jugular vein. This evidence is based on several studies documenting anatomical variations of the internal jugular vein. Ultrasound guidance has significantly decreased the incidence of serious complications of jugular vein cannulation. Finally, a specific technique of catheter placement with variations for catheter types is described.
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Affiliation(s)
- J Work
- Department of Medicine, Nephrology Division, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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26
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Affiliation(s)
- D Pashankar
- Division of Gastroenterology, British Columbia's Children's Hospital, Vancouver, Canada
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