Thoracic outlet syndrome in hemodialysis patients

Venous Thoracic Outlet Syndrome in dialysis patients (AVF- VTOS) is a poorly recognized entity. Symptomatic central venous stenosis in dialysis patients is a vexing problem with no unified treatment approach. Careful consideration of the dialysis shunt is required for thorough evaluation. Existing literature for treatment options focuses primarily on endovascular treatments, but lumps together all central venous lesions, making it challenging to tease out the subclavian venous stenoses that are likely related to thoracic outlet compression. Thoracic outlet stenosis in dialysis patients clearly does exist as evidenced by recurrence at that location and fractured stents. We propose evaluation and treatment considerations.