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Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, Schellack J, Kumbala D. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. FRONTIERS IN NEPHROLOGY 2023; 3:1280666. [PMID: 38022724 PMCID: PMC10664753 DOI: 10.3389/fneph.2023.1280666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Abdulkareem Lukan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Gaurav Sharma
- Department of Nephrology, AIIMS Rishikesh, Rishikesh, India
| | - Indranill Basu-Ray
- Department of Cardiology, AIIMS Rishikesh, Rishikesh, India
- Department of Cardiovascular Disease, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
| | - London Guidry
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Jon Schellack
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Damodar Kumbala
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
- Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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Meric M, Oztas DM, Cakir MS, Ulukan MO, Sayin OA, Kilickesmez O, Erdinc I, Rodoplu O, Oteyaka E, Ugurlucan M. A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature. Vascular 2023; 31:1017-1025. [PMID: 35549494 DOI: 10.1177/17085381221092502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. METHODS The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. RESULTS Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. CONCLUSION In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.
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Affiliation(s)
- Mert Meric
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Didem Melis Oztas
- Cardiovascular Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Semih Cakir
- Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozer Ulukan
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omer Ali Sayin
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Ibrahim Erdinc
- Cardiovascular Surgery Clinic, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Orhan Rodoplu
- Cardiovascular Surgery Clinic, Atasehir Florence Nightingale Hospital, Istanbul, Turkey
| | - Emre Oteyaka
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
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Wan Z, Lai Q, Zhou Y, Chen L, Gao X, Tu B, Chen B. Clinical characteristics of hemodialysis patients with left brachiocephalic vein obstruction due to extrinsic compression or prior catheterization. J Vasc Access 2023:11297298231184649. [PMID: 37464769 DOI: 10.1177/11297298231184649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Left brachiocephalic vein (LBCV) stenosis is a common complication in hemodialysis patients and is a heterogenous disorder associated with either prior catheterization or extrinsic compression. This study aimed to characterize patients with LBCV stenosis or occlusion with and without a history of central venous catheterization. METHODS We performed a retrospective study in 84 hemodialysis patients with LBCV stenosis or occlusion with (n = 22) or without (n = 62) prior catheterization. We compared the clinical features, anatomical factors, restenosis after balloon venoplasty, and patency rates of patients in these two groups. RESULTS In the cohort of 84 patients with LBCV stenosis or occlusion, 73.8% (62 patients) of them had no history of catheterization. Patients without prior catheterization had more stenotic lesions (p < 0.05) but less occlusive lesions (p < 0.05) than patients with prior catheterization. The space between the sternum and the aorta was narrower in patients without prior catheterization than that in patients with prior catheterization (p < 0.05). Percutaneous venography was performed in 81 patients, and the occurrence of recoil after venoplasty in patients without prior catheterization was significantly higher than that in patients with prior catheterization (p < 0.05). The rate of stent implantation was significantly higher in patients without prior catheterization than patients with prior catheterization (p < 0.05), whereas there was no significant difference in primary patency between the two groups. CONCLUSIONS LBCV stenosis and occlusion are mainly due to extrinsic compression rather than prior central venous catheterization. Stent implantation is frequently required after venoplasty to treat LBCV obstructive lesions in patients without prior catheterization.
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Affiliation(s)
- Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Qiquan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Yu Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Ling Chen
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Xuejing Gao
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Bo Tu
- Departments of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Bo Chen
- Departments of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
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Nayak-Rao S, Ramanna B, Subramanyam K, Shenoy MP, Kamath J. Endovascular Intervention for Central Venous Stenosis in Hemodialysis Patients: A Single-center Experience. Indian J Nephrol 2021; 30:337-341. [PMID: 33707823 PMCID: PMC7869648 DOI: 10.4103/ijn.ijn_343_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/26/2020] [Indexed: 12/03/2022] Open
Abstract
Central venous stenosis (CVS) refers to a significant stenosis of a large intrathoracic vein, such as the subclavian, brachiocephalic, or the superior vena cava (hemodialysis, HD). Percutaneous transluminal angioplasty (PTA) with or without stent placement has been the recommended as the preferred approach to CVS. A total of 10 consecutive HD patients with documented CVS over a 2-year time period from April 2017-April 2019 underwent percutaneous angioplasty and stent insertions under sedation. The procedure was performed by the interventional cardiologist in the institute. One patient underwent only PTA, whereas nine (90%) had PTA with primary stent insertion. Primary patency was 90% at 3 months, 80% at 6 months while at 12 months, it was 70% and remained at 70% at 24 months. We did not find any association between age, gender, diabetic status, dialysis vintage, or previous catheter infection with procedural patency. Central venous stenosis can be treated successfully with percutaneous angioplasty and primary stenting. Despite advances, prevention of CVS should be the primary approach.
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Affiliation(s)
- Shobhana Nayak-Rao
- Department of Nephrology, KS Hegde Medical Academy, Derlakatte, Karnataka, India
| | - Bhanushree Ramanna
- Department of Cardiology, KS. Hegde Medical Academy, Mangalore, Karnataka, India
| | - K Subramanyam
- Department of Cardiology, KS. Hegde Medical Academy, Mangalore, Karnataka, India
| | - M Pradeep Shenoy
- Department of Nephrology, KS Hegde Medical Academy, Derlakatte, Karnataka, India
| | - Janardhan Kamath
- Department of Nephrology, KS Hegde Medical Academy, Derlakatte, Karnataka, India
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Hemodialysis as a Risk Factor for Lower Right Internal Jugular Stenosis in Cardiac Surgery Patients: A Retrospective Single-Center Study. J Clin Med 2021; 10:jcm10051042. [PMID: 33802444 PMCID: PMC7959313 DOI: 10.3390/jcm10051042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022] Open
Abstract
Lower right internal jugular vein (RIJ) stenosis has been reported as a common cause of RIJ catheterization failure. However, the risk factors for lower RIJ stenosis in patients undergoing cardiac surgery is unclear. We reviewed the electronic medical records of all adult patients who had undergone cardiac operations in a single tertiary university hospital from January 2014 to January 2016. Patients were excluded if they were lack of preoperative contrast-enhanced chest computed tomography (CT) studies. Lower RIJ stenosis was defined as a ratio of cross-sectional area at the smallest level to cross-sectional area at the largest level less than 25%. Multivariable logistic regression analyses were used to investigate the risk factors for lower RIJ stenosis. A sensitivity analysis was also conducted using a cross-sectional area ratio of under 20%. The analysis included 889 patients, and the incidence of lower RIJ stenosis was 3.9%. The multivariable logistic regression analyses revealed that hemodialysis was an independent risk factor for lower RIJ stenosis (OR, 3.54; 95% CI, 1.472–8.514). Sensitivity analysis provided that hemodialysis (OR, 10.842; 95% CI, 3.589–32.75) was a significant predictor of cross-sectional area ratio <20%. Preoperative hemodialysis are significantly associated with an increased risk of lower RIJ stenosis in patients undergoing cardiac surgery. Extra care is needed during central venous catheterization in hemodialysis patients undergoing cardiac surgery.
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Reduced patency in left-sided arteriovenous grafts in a porcine model. J Vasc Surg 2019; 72:305-317.e6. [PMID: 31699515 DOI: 10.1016/j.jvs.2019.06.221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The porcine arteriovenous graft model is commonly used to study hemodialysis vascular access failure, with most studies using a bilateral, paired-site approach in either the neck or femoral vessels. In humans, left- and right-sided central veins have different anatomy and diameters, and left-sided central vein catheters have worse outcomes. We assessed the effect of laterality on arteriovenous prosthetic graft patency and hypothesized that left-sided carotid-jugular arteriovenous prosthetic grafts have reduced patency in the porcine model. METHODS Arteriovenous polytetrafluoroethylene grafts were placed ipsilaterally or bilaterally in 10 Yorkshire male pigs from the common carotid artery to the internal jugular vein. Ultrasound measurements of blood flow velocities and diameters were assessed before graft placement. Animals were sacrificed at 1 week, 2 weeks, or 3 weeks. Patency was determined clinically; grafts and perianastomotic vessels were excised and analyzed with histology and immunostaining. RESULTS At baseline, left- and right-sided veins and arteries had similar blood flow velocities. Although internal jugular veins had similar diameters at baseline, left-sided carotid arteries had 11% smaller outer diameters (P = .0354). There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; only 4 of 10 (40%) grafts were patent on the left compared with 7 of 8 (88%) grafts patent on the right (P = .04). Left-sided grafts had increased macrophages at the arterial anastomosis (P = .0007). Left-sided perianastomotic arteries had thicker walls (0.74 vs 0.60 mm; P = .0211) with increased intima-media area (1.14 vs 0.77 mm2; P = .0169) as well as a trend toward 38% smaller luminal diameter (1.6 vs 2.5 mm; P = .0668) and 20% smaller outer diameter (3.0 vs 3.7 mm; P = .0861). Left- and right-sided perianastomotic veins were similar histologically, but left-sided veins had decreased expression of phosphorylated endothelial nitric oxide synthase (P = .0032) and increased numbers of α-actin-positive smooth muscle cells (P = .0022). CONCLUSIONS Left-sided arteriovenous grafts are associated with reduced short-term patency compared with right-sided grafts in the Yorkshire pig preclinical model of arteriovenous prosthetic grafts. Laterality must be considered in planning and interpreting surgical preclinical models.
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Huang Y, Chen B, Tan G, Cheng G, Zhang Y, Li J, Yang J. The feasibility and safety of a through-and-through wire technique for central venous occlusion in dialysis patients. BMC Cardiovasc Disord 2016; 16:250. [PMID: 27923353 PMCID: PMC5142130 DOI: 10.1186/s12872-016-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background To retrospectively compare the operation time, success rate and efficacy between unidirectional and bidirectional procedures in the treatment of central venous occlusion diseases (CVOD), assess the advantages of the bidirectional approach, and determine the characteristics of CVOD appropriate for the bidirectional approach treatment. Methods A total of 49 patients who underwent endovascular interventions with all relevant data between January 2011 and December 2015 at the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, were included in this retrospective study, and were categorized into two groups: the 19 patients in group 1 had undergone percutaneous transluminal venoplasty (PTV) via a conventional technique (unidirectional procedure from the vein distal or proximal to the obstructive lesion), and the 30 in group 2 had undergone flossing wire technique (bidirectional procedure from femoral vein and the vein distal to obstructive lesion and using a flossing wire technique). The technical success rate, the fluoroscopy time in the procedure, perioperative complications, and patency were evaluated retrospectively. Results Compared with group 1, group 2 had a higher initial technical success rate (83.33% vs. 47.36%, p = 0.012) but a shorter fluoroscopy time (82.6 ± 26.1 vs. 116.1 ± 42.1, p = 0.048). Receiver operating characteristic (ROC) analysis indicated that a lesion with a length of 6.5 cm was the best predictor of technique success (p = 0.02) in group 1, but no cut-off value was identified for group 2. There were no significant differences in perioperative complications between these two groups. The complication rates were 31.58% (6/19) in group 1 and 6.67% (2/30) in group 2, (p = 0.043), respectively. No significant difference was observed between these two groups with respect to the stent patency rate. Conclusion Compared with the conventional technique, the flossing wire technique has a higher success rate, shorter fluoroscopy time, fewer complications and similar patency rate. It is a feasible treatment for CVOD, especially for long obstructive lesions.
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Affiliation(s)
- Yonghui Huang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
| | - Bing Chen
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Guosheng Tan
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Gang Cheng
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Yi Zhang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jiaping Li
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jianyong Yang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
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Surowiec SM, Fegley AJ, Tanski WJ, Sivamurthy N, Illig KA, Lee DE, Waldman DL, Green RM, Davies MG. Endovascular Management of Central Venous Stenoses in the Hemodialysis Patient: Results of Percutaneous Therapy. Vasc Endovascular Surg 2016; 38:349-54. [PMID: 15306953 DOI: 10.1177/153857440403800407] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine the functional results of transvenous angioplasty for the treatment of central venous stenoses in patients with failing upper extremity arteriovenous access. Two hundred consecutive patients presented with threatened arteriovenous access from January 1999 through July 2002. Angiographic evidence of central venous stenosis was present in 35 patients (18%) (superior vena cava 5, brachiocephalic veins 14, and subclavian veins 18). Follow-up averaged 873 days from the date of initial intervention. The initial technical success rate was 89%. Primary patency for each intervention was 85% at 30 days, 55% at 6 months, 43% at 1 year, and 0% at 2 years. Assisted primary patency rates were 88% at 30 days, 80% at 1 year, and 64% at 2 years. Freedom from central venous dialysis catheter placement was 82% at 30 days, 63% at 3 months, 51% at 1 year, 37% at 2 years, and 25% at 3 years. Freedom from a dialysis catheter was superior in those patients with autogenous arteriovenous fistulas. Transvenous angioplasty appears to be beneficial for hemodialysis patients with central venous stenoses, and it helps preserve functional access in the affected extremity, particularly in patients with autogenous fistulas.
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Affiliation(s)
- Scott M Surowiec
- Center For Vascular Disease, Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
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Yadav MK, Sharma M, Lal A, Gupta V, Sharma A, Khandelwal N. Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis - Preliminary experience in a tertiary care center. Indian J Radiol Imaging 2016; 25:368-74. [PMID: 26752817 PMCID: PMC4693385 DOI: 10.4103/0971-3026.169463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis. Settings and Design: This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. Materials and Methods: Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively. Results and Conclusion: A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease.
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Affiliation(s)
- Mukesh K Yadav
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Madhurima Sharma
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Anupam Lal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Vivek Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Ashish Sharma
- Department of Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Krycińska R, Trznadel A, Kuchalska P, Lis M, Dołęga-Kozierowski B, Dyś K, Drelichowski S, Witkiewicz W. Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient - Case Report and Literature Review. Pol J Radiol 2015; 80:247-51. [PMID: 26000070 PMCID: PMC4432621 DOI: 10.12659/pjr.893358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/23/2015] [Indexed: 11/24/2022] Open
Abstract
Background Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains. Case Report 61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by “body floss” technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self – expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center. Conclusions Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.
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Affiliation(s)
- Róża Krycińska
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Agata Trznadel
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Paulina Kuchalska
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Michał Lis
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Bartosz Dołęga-Kozierowski
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Krzysztof Dyś
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Stanisław Drelichowski
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Wojciech Witkiewicz
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
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Shi Y, Cheng J, Song Y, Zhang J. Anatomical factors associated with left innominate vein stenosis in hemodialysis patients. Hemodial Int 2014; 18:793-8. [PMID: 24405970 DOI: 10.1111/hdi.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yaxue Shi
- Department of Vascular Surgery; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Jiejun Cheng
- Department of Radiology; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Yanyan Song
- Department of Pharmacology and Biostatistics; Institute of Medical Sciences, School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Jiwei Zhang
- Department of Vascular Surgery; Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai China
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Ejima K, Shoda M, Manaka T, Yashiro B, Kato K, Yoshida K, Nuki T, Hagiwara N. Left brachiocephalic vein occlusion in a patient with an aortic arch aneurysm: Rare cause of obstraction for a pacemaker implantation. J Cardiol Cases 2014; 9:32-34. [DOI: 10.1016/j.jccase.2013.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/28/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022] Open
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Zhao Y, Cui T, Yu Y, Liu F, Fu P, Zhou L, Li X. Successful tunneled catheter placement in a hemodialysis patient with idiopathic multiple central venous stenoses. Hemodial Int 2013; 18:200-4. [PMID: 23879465 DOI: 10.1111/hdi.12067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuliang Zhao
- West China Medical School; Sichuan University; Chengdu China
| | - Tianlei Cui
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Yang Yu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Fang Liu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Ping Fu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Li Zhou
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Xiao Li
- Department of Gastroenterology; West China Hospital; Sichuan University; Chengdu China
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Abstract
Central vein stenosis (CVS) is commonly seen in patients receiving hemodialysis through an arteriovenous access, threatening the usability of arteriovenous access for dialysis. Subclavian and internal jugular catheters are prime reasons for the development of CVS, especially in the setting of long-term use of multiple catheters. CVS related to cardiac rhythm devices also is seen frequently. Idiopathic CVS can be encountered, although it is less common. Clinical features ultimately become sufficiently prominent to prompt angiographic evaluation. CVS should be evaluated carefully because management must be individualized. The primary method for treatment of CVS is endovascular intervention, including angioplasty and stent placement, whereas surgical options should be pursued in only refractory cases due to the invasiveness of the intervention. Early referral of patients for chronic kidney disease care; timely discussion of kidney replacement modality choices, including nonhemodialysis options such as peritoneal dialysis and kidney transplantation; placement of arteriovenous access prior to the onset of dialysis; and avoidance of catheters and other central vein instrumentation will prevent the development of CVS in most patients with kidney disease.
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Affiliation(s)
- Anil K Agarwal
- Interventional Nephrology, The Ohio State University, Columbus, OH 43210, USA.
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15
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Kotoda A, Akimoto T, Sugase T, Yamamoto H, Kusano E. Is there a link between the structural impact of thoracic outlet and the development of central venous stenosis? Med Hypotheses 2012; 80:29-31. [PMID: 23098374 DOI: 10.1016/j.mehy.2012.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Central venous stenosis (CVS) is a serious complication for chronic hemodialysis (HD) patients. Previous reports of CVS have focused on prior central venous catheterization, because of the higher prevalence and potential for prevention of such an event. However, recent studies have demonstrated that CVS may also develop without a history of central venous catheterization. Although information about the etiological backgrounds regarding the development of CVS without previous central venous catheterization have gradually accumulated, the clinical impact of the chronic compression of the central venous system by the surrounding structures, which may likely determine the central venous susceptibility to CVS, remains poorly understood. This study proposes the hypothesis that the combination of chronic venous compression at the level of thoracic outlet characterized by the natural physique and elevated venous flow induced by the creation of vascular access should be evaluated as a potential factor for the development of CVS, since they may accelerate the development of venous stenosis, presumably through the stimulation of intimal hyperplasia, and thereby the subclavian venous susceptibility to CVS should be determined.
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Affiliation(s)
- Atsushi Kotoda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi 329-0498, Japan
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16
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Central Venous Stenosis Among Hemodialysis Patients is Often Not Associated With Previous Central Venous Catheters. ASAIO J 2011; 57:439-43. [DOI: 10.1097/mat.0b013e3182246bf8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Jones RG, Willis AP, Jones C, McCafferty IJ, Riley PL. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol 2011; 22:1240-5. [PMID: 21764328 DOI: 10.1016/j.jvir.2011.06.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 05/29/2011] [Accepted: 06/07/2011] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To determine the effectiveness of stent-grafts for the treatment of central venous disease in hemodialysis patients with functioning arteriovenous (AV) fistulas. MATERIALS AND METHODS Between October 2004 and March 2010, 42 VIABAHN stent-grafts were deployed in central veins of 30 patients (16 men, 14 women; mean age 60 y) with functioning AV fistulas and central venous disease that did not respond to percutaneous transluminal angioplasty (PTA). Eighteen patients had central vein stenosis and 12 had occlusion. Previous PTA and/or bare metal stent placement had been performed in 23 patients (77%). Surveillance was carried out at 3, 6, 9, 12, 18, and 24 months with diagnostic fistulography. The mean follow-up was 705 days (range, 66-1,645 d). Statistical analysis included Kaplan-Meier and log-rank studies. RESULTS Technical success rate was 100%. Primary patency rates were 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively. Primary assisted patency rates were 100%, 100%, 80%, and 75% at 3, 6, 12, and 24 months, respectively. Patients without previous procedures had significantly shorter times to repeat intervention (P = .018) than those who had undergone PTA or bare metal stent placement previously. Patients with occlusive lesions had a significantly shorter primary patency interval (P = .05) than patients with stenoses. Occluded veins were more likely to require further stent-grafts (P = .02). Twelve patients required further stent-grafts to maintain patency. There was one minor complication. CONCLUSIONS Stent-graft placement to treat central venous disease in hemodialysis patients with autogenous AV fistulas is safe and effective if PTA fails to maintain luminal patency.
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Affiliation(s)
- Robert G Jones
- Radiology Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, United Kingdom.
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18
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Mokrzycki MH, Lok CE. Traditional and non-traditional strategies to optimize catheter function: go with more flow. Kidney Int 2010; 78:1218-31. [DOI: 10.1038/ki.2010.332] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Abstract
Central vein stenosis (CVS) is a common complication of the central venous catheter (CVC) placement. The prevalence of CVS has mostly been studied in those who present with symptoms such as swelling of the extremity, neck and breast. CVS compromises arteriovenous access and can be resistant to treatment. A previous history of CVC placement is the most important risk factor for the development of CVS later. Pacemaker and defibrillator wires are associated with a high incidence of CVS. Increasingly liberal use of peripherally inserted central catheters (PICC) is likely to increase the incidence of CVS. The trauma and inflammation related to the catheter placement is thought to result in microthrombi formation, intimal hyperplasia and fibrotic response, with development of CVS. Treatment of CVS by endovascular procedures involves angioplasty of the stenosis. An elastic or recurrent stenosis may require a stent placement. The long-term benefits of the endovascular procedures, although improved with newer technology, remain modest. Surgical options are usually limited. Future studies to explore the pathogenesis and the use of novel therapies to prevent and treat CVS are needed. The key to reducing the prevalence of CVS is in reducing CVC placement and placement of arteriovenous accesses prior to initiating dialysis. Early referral of the patients to the nephrologists by the primary care physicians is important. Timely vein mapping and referral to the surgeon for fistula creation can obviate the need for a CVC and decrease incidence of CVS.
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20
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Nael K, Kee ST, Solomon H, Katz SG. Endovascular Management of Central Thoracic Veno-Occlusive Diseases in Hemodialysis Patients: A Single Institutional Experience in 69 Consecutive Patients. J Vasc Interv Radiol 2009; 20:46-51. [DOI: 10.1016/j.jvir.2008.09.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 09/15/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022] Open
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21
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Liangos O, Gul A, Madias NE, Jaber BL. UNRESOLVED ISSUES IN DIALYSIS: Long-Term Management of the Tunneled Venous Catheter. Semin Dial 2006; 19:158-64. [PMID: 16551295 DOI: 10.1111/j.1525-139x.2006.00143.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite their propensity for significant complications, tunneled central venous catheters have become a common means of vascular access in the United States for patients requiring maintenance hemodialysis for end-stage renal disease (ESRD). Reasons for their use include advanced patient age, peripheral vascular disease (arterial and venous), late referral for creation of vascular access, and more importantly, the lack of an interdisciplinary service line on vascular access among vascular surgeons, radiologists, and nephrologists. This review article summarizes complications commonly encountered in dialysis patients who use tunneled central venous catheters for vascular access-mainly thrombosis, stenosis, and infection. Special attention is given to novel approaches for the prevention of catheter-associated infections. Effective prevention and timely treatment of common catheter-associated complications can reduce the substantial morbidity associated with the use of these devices. However, these measures should not detract from the goal of avoiding or limiting the long-term use of catheters, thereby optimizing vascular access management by ensuring the timely availability of functioning arteriovenous fistulas.
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Affiliation(s)
- Orfeas Liangos
- Department of Medicine, Tufts University School of Medicine, Caritas St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA
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22
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Oginosawa Y, Abe H, Nakashima Y. Prevalence of venous anatomic variants and occlusion among patients undergoing implantation of transvenous leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:425-8. [PMID: 15869675 DOI: 10.1111/j.1540-8159.2005.09534.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The implantation of transvenous leads may be prohibited by venous occlusion or anatomical variants. The prevalence of these conditions among patients undergoing transvenous pacing or implantable cardioverter defibrillator (ICD) leads implantation has not been systematically studied. This study examined the prevalence of venous anatomic variants and/or venous occlusion, and related risk factors, prior to lead implantation. METHOD The study included 273 consecutive patients scheduled for implantation of transvenous pacing or ICD leads. Before the procedure, the venous network of arms, neck, and thorax was evaluated by bilateral intravenous digital subtraction angiography (DSA). RESULTS Complete venous occlusion associated with developed collateral circulation was observed in 12 patients (4.4%); at the site of the left innominate vein in 9, left subclavian vein in 2, and right subclavian vein in 1 patient. Of 12 patients with venous occlusion, 7 patients had a history of prior surgical procedure. A persistent left superior vena cava was observed in 1 patient (0.4%). The presence of abnormal findings on DSA was significantly higher on the left than the right side (P < 0.001). The cardio-thoracic ratio (CTR) was significantly greater in patients with venous occlusions than patients with normal circulation (P = 0.012). CONCLUSIONS Asymptomatic venous abnormalities are not rare among patients requiring transvenous pacing lead implantation. Careful attention should be paid when implanting pacing or ICD leads from the left side, especially in patients with an increased CTR or history of prior insertion for central venous catheter.
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Affiliation(s)
- Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Yahatan-ishi, Kitakyushu, Japan
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23
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Oguzkurt L, Tercan F, Yildirim S, Torun D. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005; 55:237-42. [PMID: 16036153 DOI: 10.1016/j.ejrad.2004.11.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 11/10/2004] [Accepted: 11/11/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. MATERIAL AND METHODS Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. RESULTS Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. CONCLUSION Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.
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Affiliation(s)
- Levent Oguzkurt
- Baskent University, Adana Teaching and Medical Research Centre, Department of Radiology, Adana, Turkey.
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