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Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft
  1. Lloyd Steele1,2,
  2. David Flowers3,
  3. Simon Coles3 and
  4. Paul Gibbs2
  1. 1 Imperial College Healthcare NHS Trust, London, UK
  2. 2 Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK
  3. 3 Department of Interventional Radiology, Queen Alexandra Hospital, Portsmouth, UK
  1. Correspondence to Dr Lloyd Steele, lloyd.steele{at}


A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.

  • interventional radiology
  • dialysis
  • chronic renal failure
  • diabetes

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  • Contributors All authors were involved in the clinical care of the patient. LS drafted the manuscript, and DF, SC and PG provided senior review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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