{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:31Z","timestamp":1756339471136,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,7]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2\u2009weeks 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\u2009year 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.<\/jats:p>","DOI":"10.1136\/bcr-2019-229398","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T09:05:15Z","timestamp":1564131915000},"page":"e229398","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft"],"prefix":"10.1136","volume":"12","author":[{"given":"Lloyd","family":"Steele","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"},{"name":"Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Flowers","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Coles","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,26]]},"reference":[{"key":"2025082707553664000_12.7.e229398.1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2002.01301.x"},{"key":"2025082707553664000_12.7.e229398.2","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1159\/000182642","article-title":"Massive upper extremity edema with arteriovenous fistula for hemodialysis. 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