Résumé
As survival for patients with renal failure continues to improve, the complexity of vascular access procedures and the complications from these procedures will continue to increase. Venous hypertension is one of the most distressing complication in patients creating ar-teriovenous fistula resulting in swelling of the ipsilaterai arm, cyanosis as well as formation of collaterals on the chest wail when associated with central venous stenosis or obstruction. From April 2002, to April 2004, 519 patients with end stage renal disease [ESRD] on regular haemodialysis with already functioning vascular access. There were 21 patients [4.2%] presented with variable degrees of oedema and venous hypertension. The patients were classified clinically into three groups: Group A : included cases with mild oedema. Group B : cases presented with moderate and painful oedema Group C : cases presented with extensive oedema of the whole limb, oedema of the ipsilateral breast, congestion, discolouration of the affected limb and cases with collaterals on the shoulder and anterior chest wall of the affected side, 21 patients representing [4.2%] of the studied cases presented with variable degrees of venous hypertension, 7 males [33%] and 14 females [67%]. All patients presented with oedema, 12 patients associated with bluish discolouration of the skin, 6 patients with increased venous pressure and one patients with venous ulcer. 14 patients had AVF without central venous line and 7 patients with history of ipsilateral central venous line. Venous dialysis pressure was > 150mmHg in 6 patients and normal in 8 patients, not measured in 6 patients. Management of patients by limb elevation and compression therapy lead to improvement of symptoms in only 4 cases. Endovascular procedures were done in 10 cases using PTA without stent in 9 cases and PTA with stent in one case. Surgery was applied for 16 cases, 3 patients underwent surgical bypass using synthetic graft for one patient and autogenous vein graft for 2 cases. Ligation of the distal veins was performed for 7 cases. Ligation of the fistula was done in 5 cases and surgical revision in one case. Venous hypertension resulted from proximal venous obstruction or stenosis or by distal venous reflux. Early detection and treatment of venou hypertension is essential to provide adequate care for chronic renal failure patients. Percutaneous Angioplasty for stenosed central vein is the method of choice in management of venous hypertension in well selected cases and surgical bypass using autogenous vein or synthetic graft is a good alternative when complete obstruction of central vein or failed endovascular technique