Massive Upper GI Bleeding in a Long-term Hemodialysis Patien

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Massive Upper GI Bleeding in a Long-term Hemodialysis Patien Chandra Alpana , MD, Tso Raymond , MD, Cynamon Jacob , MD, Miller Gregg , MD CHEST Volume 128, Issue 3, Pages 1868-1873 (September 2005) DOI: 10.1378/chest.128.3.1868 Copyright © 2005 The American College of Chest Physicians Terms and Conditions

Figure 1 Left-upper-extremity venogram showing obstruction of innominate vein due to the presence of the hemodialysis catheter and thrombosis around the catheter. CHEST 2005 128, 1868-1873DOI: (10.1378/chest.128.3.1868) Copyright © 2005 The American College of Chest Physicians Terms and Conditions

Figure 2 Same day, after AngioJet and angioplasty procedure with the sheath in situ (solid arrow). Now there is prograde flow to innominate vein and SVC also showing presence of collaterals. The hemocath (dotted arrow) was left in place. CHEST 2005 128, 1868-1873DOI: (10.1378/chest.128.3.1868) Copyright © 2005 The American College of Chest Physicians Terms and Conditions

Figure 3 A repeat angiogram 5 days later showing partial resolution of thrombosis on venography, showing prograde flow and decrease in collaterals. The hemocath was removed (dotted arrow) and sheath was placed over guidewire (solid arrow). CHEST 2005 128, 1868-1873DOI: (10.1378/chest.128.3.1868) Copyright © 2005 The American College of Chest Physicians Terms and Conditions

Figure 4 Self-expandable stent in the SVC (solid arrow). CHEST 2005 128, 1868-1873DOI: (10.1378/chest.128.3.1868) Copyright © 2005 The American College of Chest Physicians Terms and Conditions