High Pressure and the Swollen Arm

The creation of an arteriovenous access in the arm dramatically alters flow dynamics, such that significant obstruction to venous outflow to the right atrium will reliably cause arm swelling unless there is adequate existing or development of collateral venous pathways for drainage. Given the presence of existing collateral pathways in the arm, obstruction of the central veins is typically required for significant arm swelling after AV access creation. A variety of management strategies can be utilized, including resolving the obstruction, bypassing the obstruction, or ligation of the arteriovenous access. The optimal option and chances for success depends on the underlying etiology of the obstruction and the clinical scenario.