Blood finds its own way: Axillary vein thrombosis with exten
The present case has been reported in the journal clinical case reports. A 49‐year‐old man with a history of end‐stage renal disease on hemodialysis for 17 years presented with shortness of breath. He had a working left upper extremity arteriovenous fistula but was previously dialyzed using catheters for several years.

A contrasted computed tomography scan was obtained to exclude pulmonary embolism, which incidentally demonstrated a large system of chest‐wall collateral vessels at the level of the right axillary vein, suggesting chronic deep vein thrombosis (DVT) in the right axillary vein. There was no occlusion in the superior vena cava. His shortness of breath improved with adequate ultrafiltration.

Key Clinical Message
• Hemodialysis catheters are associated with upper extremity deep vein thrombosis, and chronic venous occlusion leads to the formation of collateral pathways.

• Knowledge of these pathways aids in accurate interpretation of upper extremity venograms. Arteriovenous fistula is the preferred access for chronic hemodialysis, and long‐term use of catheters should be avoided.

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