Painful edema of the arm after insertion of single-needle subclavian vein dialysis catheters: pathogenesis and treatment

The percutaneous subclavian vein hemodialysis catheter, which is widely used for vascular access in patients with renal failure, can give rise to several complications. Asymptomatic stenosis or occlusion of the subclavian vein due to these catheters can lead to painful arm edema if further dialysis accesses are constructed in the ipsilateral arm. This complication can lead to loss of valuable dialysis fistulas or grafts. We present six cases of this complication, along with management alternatives, which include conservative elevation, ligation of shunts, and surgical bypass of stenosed veins. Awareness of this complication should encourage early evaluation of patients who have had subclavian catheters and guide future placement of dialysis shunts. To preserve dialysis access sites, we advise an individualized approach to each patient who develops this painful arm edema.