Which of the following is a venous access complication?

• A. Thrombosis
• B. Stenosis
• C. Arterial Steal
• D. Distal Venous HTN

Answer: (D)

The concept here is recognizing a complication that directly involves the venous side of a dialysis access. Distal venous hypertension arises when the venous drainage from the access is excessive or obstructed, causing elevated venous pressure in the limb downstream from the access. This increased distal venous pressure leads to swelling, venous engorgement, and pain, and can even threaten the limb and the function of the access if severe. It’s a venous-side problem tied to how much pressure the venous system has to handle after the access.

Thrombosis would be an occlusive blockage of the access itself, not a pressure-related issue in the distal vein. Stenosis involves narrowing of the vein, which can disrupt flow but isn’t the same as the distal pressure elevation seen in DVH. Arterial steal is a problem of arterial flow being diverted into the access, causing distal ischemia rather than venous hypertension. So, the scenario most specifically describing a venous access complication with distal pressure effects is distal venous hypertension.