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Aimanan K, Ong MN, Koay KL, Siew CYE, Hayati F, Tajri H. Veno-Venous Surgical Bypass for Central Vein Occlusion in a Child: The First in the Literature. EJVES Vasc Forum 2023; 59:56-58. [PMID: 37396436 PMCID: PMC10310466 DOI: 10.1016/j.ejvsvf.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/11/2023] [Accepted: 05/15/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction During the past two decades, the incidence of chronic kidney disease (CKD) in children worldwide has steadily increased and, even in children, native arteriovenous fistula (AVF) remains the access of choice. Nevertheless, maintaining a well functioning fistula is limited by central venous occlusion due to the widespread use of central venous access devices before AVF creation. Report A 10 year old girl with end stage renal failure dialysing through a left brachiocephalic fistula presented with left upper limb and facial swelling. She had previously exhausted the option of ambulatory peritoneal dialysis for recurrent peritonitis. A central venogram showed occlusion at the left subclavian vein, which was not amenable for angioplasty through either an upper limb or femoral approach. Given the precious fistula with concomitant worsening venous hypertension, an ipsilateral axillary vein to external iliac vein bypass was performed. Subsequently, her venous hypertension was significantly resolved. This report is the first in English literature on this surgical bypass in a child with central venous occlusion. Discussion Central venous stenosis or occlusion rates are rising due to extensive central venous catheter use in the paediatric population with end stage renal failure. In this report, an ipsilateral axillary vein to external iliac vein bypass was used successfully as a safe temporary option to maintain AVF. Ensuring a high flow fistula pre-operatively and continued antiplatelet post-operatively will allow longer patency of the graft.
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Affiliation(s)
- Karthigesu Aimanan
- Department of Vascular Surgery, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
| | - Mang Ning Ong
- Department of Vascular Surgery, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
| | - Kean Leong Koay
- Department of Vascular Surgery, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
| | - Caroline Yin Eng Siew
- Department of Paediatrics, Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia, Seremban, Negeri Sembilan, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Hafizan Tajri
- Department of Vascular Surgery, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
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Zhao Y, Zhao Q, Wei W, Yang L, Yu Y, Zhou L, Fu P, Cui T. Percutaneous superior vena cava puncture for hemodialysis catheter placement. J Vasc Surg Venous Lymphat Disord 2023; 11:318-25. [PMID: 36179787 DOI: 10.1016/j.jvsv.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/09/2022] [Accepted: 07/26/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Central venous occlusion (CVO) refractory to endovascular angioplasty is a critical challenge that threatens hemodialysis vascular access. In the present study, we evaluated the efficacy and safety of tunneled, cuffed central venous catheter (tCVC) placement via percutaneous superior vena cava (SVC) puncture in patients with refractory CVO. METHODS Patients requiring maintenance hemodialysis with refractory CVO who had undergone percutaneous SVC puncture and tCVC insertion at a university-affiliated hospital from January 2016 to June 2020 were included. The patients were followed up until May 2021. The demographic information, complications, and catheter patency were analyzed. RESULTS A total of 205 patients (105 women [51.2%]; mean age, 61 ± 15 years) were included. The SVC puncture and tCVC insertion were successfully performed in 194 patients, for a technical success rate of 94.6%. One patient had experienced a pleura injury and hemothorax and had required urgent thoracotomy. A total of 37 patients had presented with mild chest pain and were prescribed oral nonsteroidal anti-inflammatory drugs. During follow-up of the 194 patients with a successful procedure, catheter dysfunction due to thrombosis had occurred in 66 patients, catheter malposition had occurred in 5 patients, and catheter-related blood stream infection had developed in 6 patients. The 3-year primary patency rate was 64.2%, and the 3-year secondary patency rate was 76.3%. CONCLUSIONS A tCVC placed through a percutaneous SVC puncture had a satisfactory technical success rate and long-term patency rate in patients requiring hemodialysis, providing an optional vascular access for those with exhausted central vein resources. SVC puncture also avoided the use of left-sided catheters and preserved central vein resources. Caution should be given to avoid potential complications such as pleura injury and hemothorax.
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Rashwan B, Shwaiki O, Partovi S, Karuppasamy K, Gill A, Gadani S. Thoracic central venous occlusion from the interventional radiology perspective. Cardiovasc Diagn Ther 2023; 13:299-310. [PMID: 36864973 PMCID: PMC9971304 DOI: 10.21037/cdt-22-93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Central venous occlusion is a common condition in certain patient populations, with significant associated morbidity. Symptoms range from mild arm swelling to respiratory distress and can be particularly troublesome in the end stage renal disease population when related to dialysis access and function. Crossing completely occluded vessels is often the most challenging step and various techniques exist to accomplish this. Traditionally, blunt and sharp recanalization techniques are used to cross occluded vessels and are described in detail. Even with experienced providers there are lesions which prove to be too difficult and are refractory to traditional approaches. We discuss advanced techniques such as with radiofrequency guidewires as well as newer technologies which offer an alternative pathway to re-establishing access. These emerging methods have demonstrated procedural success in the majority of cases where traditional techniques were futile. Following recanalization, angioplasty with or without stenting is typically performed and restenosis is a commonly encountered complication. We discuss angioplasty and the emerging use of drug-eluting balloons in venous thrombosis. Subsequently, in regards to stenting we discuss the indications and multitude of available types including novel venous stents with their respective strengths and drawbacks. Potential feared complications such as venous rupture with balloon angioplasty and stent migration are discussed along with our recommendations to reduce their risk of occurrence and promptly manage them when they do unfortunately occur.
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Affiliation(s)
- Basem Rashwan
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Omar Shwaiki
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sasan Partovi
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Amanjit Gill
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sameer Gadani
- Department of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Benfor B, Chinnadurai P, Peden EK. Advanced intraoperative imaging guidance for inside-out central venous recanalization using a novel catheter access system. J Vasc Surg Venous Lymphat Disord 2022; 10:1334-1342.e1. [PMID: 35940445 DOI: 10.1016/j.jvsv.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/27/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The novel Surfacer Inside-Out recanalization technique facilitates right-sided central venous access in occluded vessels but carries a risk of arterial and pleural injuries. This article demonstrates how an advanced intraoperative imaging protocol can help to avoid these potential complications. METHODS This retrospective review included patients undergoing the Surfacer Inside-Out central venous recanalization procedure between December 2017 and October 2021. The study sample comprised patients included in the SAVE-US trial at our site as well as patients treated after US Food and Drug Administration approval of the device. All procedures were performed using intraoperative cone-beam computed tomography (CBCT) angiography to map out the trajectory of the device through the mediastinum and supraclavicular space with fusion imaging for guidance. Procedures were aborted if CBCT findings predicted injury to arterial or respiratory structures. The intraoperative coronal and sagittal orientation of the device was compared to preoperatively predicted trajectory. RESULTS A total of 17 procedures were performed in 16 patients with end-stage renal disease and a mean age of 61 ± 11 years. Most patients presented a type 3 central venous occlusion (9/15). Successful recanalization was achieved in 14 of the 17 cases (82.4%) with no intraoperative complications. The procedure had to be aborted in 3 of the 17 cases based on intraoperative CBCT findings, which projected the device to perforate the right pleural space in one patient, the trachea and right subclavian artery in another, and the innominate artery in the third patient. The total radiation dose per procedure was 753 ± 346 mGy and the mean procedural time was 101.6 ± 29.7 minutes. A median of 2 (range, 1-5) intraoperative CBCT scans were performed per patient and accounted for 70% of the total radiation dose. Statistical analysis showed intraoperative CBCT findings to differ significantly from preoperative predicted values. CONCLUSIONS The nonsteerable and penetrating nature of the Surfacer device may lead to serious complications when performed under fluoroscopic guidance alone. Intraoperative CBCT with fusion overlay enhances the safety and effective use of this device and inside out crossing technique.
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Affiliation(s)
- Bright Benfor
- Department of Vascular Surgery, Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
| | | | - Eric K Peden
- Department of Vascular Surgery, Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
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Alomari MH, Amarneh MA, Shahin MM, Kerr CL, Variyam D, Chewning R, Chaudry G, Padua H, Shaikh R, Fishman SJ, Alomari AI. The use of the internal mammary vein for central venous access. J Pediatr Surg 2021; 56:816-820. [PMID: 33422328 DOI: 10.1016/j.jpedsurg.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the use of the internal mammary vein as an alternative access for central venous catheters. METHODS We performed a retrospective review of patients who underwent placement of central venous catheters via the internal mammary vein. Patient demographics, indication for venous access, technical success, catheter type, dwell time and indication for exchange or removal were recorded. RESULTS Placement of central venous catheters via the internal mammary vein was attempted in 11 patients including 8 children (4 males, mean age 5.7 years) and 3 adults. The most common indication was parenteral nutrition in patients with intestinal failure (7/11). Initial needle access of the vein was successful in all patients. Catheter placement was successful in 9 and unsuccessful in 2 patients due to occlusion of the superior vena cava. There were no immediate complications. A total of 20 catheters of various sizes (3-14.5 French) and lengths (8-23 cm) were either placed (n = 12) or exchanged (n = 8). The most common indications for catheter exchange were poor function and malposition (7/8). Four catheters were removed for infection and 4 were accidentally removed. The mean dwell time was 141 days (range 0-963 days) per catheter for a total of 2829 catheter days. The total mean dwell time per patient, including primarily placed and exchanged catheters, was 314 days (range 5-963 days). CONCLUSIONS The internal mammary vein may provide a safe alternative route for patients who have lost their traditional access veins.
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Affiliation(s)
- Mohammed H Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Mohammad A Amarneh
- Division of Vascular and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohamed M Shahin
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Cindy L Kerr
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Darshan Variyam
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Rush Chewning
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Horacio Padua
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Raja Shaikh
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Steven J Fishman
- Department of Surgery, Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Boston Children's Hospital, and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Mirza MH, Schwertner A, Kohlbrenner R, Dowd CF, Narsinh KH. Intracranial hemorrhage due to central venous occlusion from hemodialysis access: A case report. Interdiscip Neurosurg 2021; 24. [PMID: 33796444 PMCID: PMC8009337 DOI: 10.1016/j.inat.2020.101081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Central venous stenosis in hemodialysis patients rarely causes venous hypertension and intracranial hemorrhage. A 54 year-old male with right arm arteriovenous fistula was transferred to our institution in a comatose state following right parietal venous infarction. Fistulography showed right brachiocephalic vein (BCV) occlusion with reflux into the right transverse sinus and obstruction of left internal jugular vein outflow due to the styloid process. Balloon venoplasty of the right BCV occlusion failed to improve the patient's status because of the delayed diagnosis. Headaches and neurologic symptoms in hemodialysis patients can herald intracranial hypertension due to central venous occlusion and needs prompt assessment with fistulography.
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Affiliation(s)
- Mohammed H Mirza
- Department of Radiology, University of Illinois College of Medicine, Peoria, IL, United States
| | - Adam Schwertner
- Department of Radiology, University of Colorado Denver School of Medicine, Denver, CO, United States
| | - Ryan Kohlbrenner
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Christopher F Dowd
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Kazim H Narsinh
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
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Young JL, McLennan G. Thoracic Central Vein Occlusion in the Dialysis Patient: An Interventional Perspective. Adv Chronic Kidney Dis 2020; 27:236-242. [PMID: 32891308 DOI: 10.1053/j.ackd.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/11/2022]
Abstract
Thoracic central venous occlusion in hemodialysis patients can cause significant disability from arm and facial swelling and can lead to worsening function of dialysis access. Current techniques for managing thoracic central venous occlusion and some of the newer techniques for achieving dialysis access when all central veins are occluded. Techniques for dealing with acute superior vena cava thrombosis will also be covered as will the complications of central venous recanalization techniques.
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Hamzan MI, Hamid AR, Halim AS, Mat Saad AZ. An unusual cause of subacute airway obstruction in a hemodialysis patient with brachio-cephalic arteriovenous fistula: A rare presentation of central venous occlusion. Hemodial Int 2020; 24:E33-E36. [PMID: 32141217 DOI: 10.1111/hdi.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
A young lady with an arteriovenous (AV) fistula on hemodialysis was referred for surgical management following a failed endovascular approach to relieve central venous occlusion. She had an obstructed left brachiocephalic vein with a history of numerous central vein catheter placements. Alternative routes for new arteriovenous fistula creation had been exhausted due to previous contralateral upper limb fistula rupture and ligation. To the best of our knowledge, no similar cases of airway obstruction in central venous occlusion occurring in hemodialysis patients with AV fistula have been reported. The importance of identifying the possible emergency red flags in hemodialysis patients with central venous occlusion is important to prevent unwanted consequences.
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Affiliation(s)
- Muhammad Izzuddin Hamzan
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Rizal Hamid
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Management and Science University Medical Centre, Shah Alam, Selangor, Malaysia
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Chen YY, Wu CK, Lin CH. Outcomes of the Gore Excluder abdominal aortic aneurysm leg endoprosthesis for treatment of central vein stenosis or occlusion in patients with chronic hemodialysis. J Vasc Surg Venous Lymphat Disord 2020; 8:195-204. [PMID: 32067725 DOI: 10.1016/j.jvsv.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Central venous occlusive disease is a critical complication in long-term hemodialysis patients with arteriovenous (AV) dialysis circuits. The purpose of this retrospective, single-arm cohort study was to evaluate the effectiveness of an abdominal aortic aneurysm (AAA) contralateral leg endoprosthesis to treat symptomatic central venous occlusive diseases in patients with chronic hemodialysis. METHODS A prospective cohort study included 60 patients on hemodialysis presenting with central venous stenosis or occlusion, who were treated with a Gore Excluder AAA contralateral leg stent graft between December 2013 and July 2018. Follow-up angiography was obtained at 3, 6, and 12 months. The outcomes and duration of primary circuit and target site patency were measured from the time of the stent graft implantation to the first reintervention for AV circuit dysfunction and target site restenosis. Secondary patency was calculated from stent graft implantation to the point when AV access was no longer attainable. RESULTS Circuit primary patency rate was 54.9% at 1 year of Gore Excluder AAA contralateral leg or iliac extender stent grafts, implanted in 60 hemodialysis patients with central vein occlusive disease. Cumulative target site primary patency rate was 88.3% at 1 year. Secondary patency rate was 95% during follow-up. Patients with concomitant lesions had a significantly higher risk of circuit primary patency dysfunction. CONCLUSIONS Treatment of central vein obstructions in hemodialysis patients with stent grafts has been appealing owing to the tapered shape with a larger diameter and the availability of various lengths.
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Affiliation(s)
- Yen-Yang Chen
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Lopez-Pena G, Anaya-Ayala JE, Garcia-Alva R, Luna L, Lizola R, Cuen-Ojeda C, Arzola LH, Hinojosa CA. Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation. J Vasc Access 2019; 21:55-59. [PMID: 31188045 DOI: 10.1177/1129729819851919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. METHODS This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients' demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. RESULTS Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). CONCLUSION Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.
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Affiliation(s)
- Gabriel Lopez-Pena
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ramon Garcia-Alva
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Lizeth Luna
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rene Lizola
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Cesar Cuen-Ojeda
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Luis H Arzola
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Carlos A Hinojosa
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Shahrouki P, Moriarty JM, Khan SN, Bista B, Kee ST, DeRubertis BG, Yoshida T, Nguyen KL, Finn JP. High resolution, 3-dimensional Ferumoxytol-enhanced cardiovascular magnetic resonance venography in central venous occlusion. J Cardiovasc Magn Reson 2019; 21:17. [PMID: 30853026 PMCID: PMC6410526 DOI: 10.1186/s12968-019-0528-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/12/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although cardiovascular magnetic resonance venography (CMRV) is generally regarded as the technique of choice for imaging the central veins, conventional CMRV is not ideal. Gadolinium-based contrast agents (GBCA) are less suited to steady state venous imaging than to first pass arterial imaging and they may be contraindicated in patients with renal impairment where evaluation of venous anatomy is frequently required. We aim to evaluate the diagnostic performance of 3-dimensional (3D) ferumoxytol-enhanced CMRV (FE-CMRV) for suspected central venous occlusion in patients with renal failure and to assess its clinical impact on patient management. METHODS In this IRB-approved and HIPAA-compliant study, 52 consecutive adult patients (47 years, IQR 32-61; 29 male) with renal impairment and suspected venous occlusion underwent FE-CMRV, following infusion of ferumoxytol. Breath-held, high resolution, 3D steady state FE-CMRV was performed through the chest, abdomen and pelvis. Two blinded reviewers independently scored twenty-one named venous segments for quality and patency. Correlative catheter venography in 14 patients was used as the reference standard for diagnostic accuracy. Retrospective chart review was conducted to determine clinical impact of FE-CMRV. Interobserver agreement was determined using Gwet's AC1 statistic. RESULTS All patients underwent technically successful FE-CMRV without any adverse events. 99.5% (1033/1038) of venous segments were of diagnostic quality (score ≥ 2/4) with very good interobserver agreement (AC1 = 0.91). Interobserver agreement for venous occlusion was also very good (AC1 = 0.93). The overall accuracy of FE-CMRV compared to catheter venography was perfect (100.0%). No additional imaging was required prior to a clinical management decision in any of the 52 patients. Twenty-four successful and uncomplicated venous interventions were carried out following pre-procedural vascular mapping with FE-CMRV. CONCLUSIONS 3D FE-CMRV is a practical, accurate and robust technique for high-resolution mapping of central thoracic, abdominal and pelvic veins and can be used to inform image-guided therapy. It may play a pivotal role in the care of patients in whom conventional contrast agents may be contraindicated or ineffective.
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Affiliation(s)
- Puja Shahrouki
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - John M. Moriarty
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sarah N. Khan
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Biraj Bista
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Stephen T. Kee
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Brian G. DeRubertis
- Department of Surgery, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Takegawa Yoshida
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, USA
| | - J. Paul Finn
- Diagnostic Cardiovascular Imaging Laboratory, University of California, Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, 90095-7206 CA USA
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, USA
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
- David Geffen School of Medicine at UCLA, Los Angeles, USA
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12
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Chick JFB, Hage AN, Patel N, Gemmete JJ, Meadows JM, Srinivasa RN. Chylothorax secondary to venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and venous reconstruction. J Vasc Surg Cases Innov Tech 2018; 4:193-196. [PMID: 30148237 PMCID: PMC6105749 DOI: 10.1016/j.jvscit.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/29/2018] [Indexed: 12/24/2022]
Abstract
A chylothorax may be due to either direct trauma or occlusion of the thoracic duct. Treatments include antegrade or retrograde glue and coil embolization as well as thoracic duct stent graft placement. This report describes a patient with chylothorax secondary to venous outflow occlusion. Left upper extremity venography demonstrated multifocal left brachiocephalic and axillary vein occlusions with retrograde filling of an engorged and disrupted thoracic duct. Retrograde thoracic duct lymphangiography with embolization and left upper extremity venous reconstruction were performed with complete resolution of chylothorax.
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Affiliation(s)
- Jeffrey Forris Beecham Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - Anthony N Hage
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - Nishant Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - Joseph J Gemmete
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - J Matthew Meadows
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, Mich
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13
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Zubair MM, Bennett ME, Peden EK. Left axillary to right atrium anterior chest wall graft using bovine carotid artery conduit. J Vasc Access 2018; 19:187-90. [PMID: 28983897 DOI: 10.5301/jva.5000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Central venous occlusive (CVO) disease involving the superior vena cava (SVC) and inferior vena cava (IVC) can occur frequently in patients with end-stage renal disease (ESRD) on chronic dialysis. Dialysis access is essential for the survival of these patients. CASE DESCRIPTION We report a case of a chest wall graft creation using bovine carotid artery conduit in a patient who was experiencing life-threatening loss of dialysis access secondary to her SVC and IVC occlusion along with a hypercoagulable state. We did a subcutaneous anterior chest wall graft from the left axillary artery to the right atrium (RA) using a mini thoracotomy incision. CONCLUSIONS ESRD patients with CVO pose a unique challenge. We believe our approach can provide an excellent option for dialysis access in patients with exhausted conventional access options.
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14
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Aye T, Phan TT, Muir DF, Linker NJ, Hartley R, Turley AJ. Novel experience of laser-assisted 'inside-out' central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation. Europace 2017; 19:1750-1753. [PMID: 27742773 DOI: 10.1093/europace/euw239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/06/2016] [Indexed: 11/12/2022] Open
Abstract
Aim This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. Method and results Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion. When encountered with impenetrable resistance, 1.4 mm Excimer laser helped delivery of a Pilot 200 wire, which then progressed towards the distal edge of occlusion. Serial balloon dilatations allowed wire tracked into subintimal plane, advanced towards left clavicle using knuckle wire technique, which was then externalized with blunt dissection from infraclavicular pocket area. It was later changed to Amplatz superstiff wire exiting from both ends to form a rail, which ultimately allowed passage of pacing leads after serial balloon dilatation from clavicular end. Conclusion Our hybrid 'inside-out' technique permitted transvenous pacemaker insertion without complication and this is, to our knowledge, the first case using laser in this context.
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Affiliation(s)
- Thandar Aye
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Thanh Trung Phan
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Douglas Findlay Muir
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Nicholas John Linker
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Richard Hartley
- Department of Radiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK
| | - Andrew John Turley
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
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15
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Carter S, van de Hoef D, Temple M, Harvey E, Al-Saleh S, Licht C, Noone D. Plastic bronchitis: a rare complication of long-term haemodialysis catheter placement in a child. Pediatr Nephrol 2017; 32:1635-8. [PMID: 28642998 DOI: 10.1007/s00467-017-3717-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite peritoneal dialysis being the preferred mode of renal replacement therapy in neonates and infants, long-term haemodialysis may be necessary in a minority of patients with its attendant risks. CASE DIAGNOSIS/TREATMENT This case identifies plastic bronchitis as a rare yet serious complication of long-term large bore vascular access when a vessel-sparing approach is not possible. CONCLUSIONS An appropriately sized catheter should be used for the dialytic therapy required and to optimize access survival.
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16
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Goudot G, Del Giudice C, Pellerin O, Courtois MC, Galloula A, Messas E, Mirault T, Sapoval M. [Recanalization procedure of the common femoral vein following iatrogenic femoral chronic occlusion: 3 cases]. J Med Vasc 2017; 42:237-243. [PMID: 28705343 DOI: 10.1016/j.jdmv.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Common femoral vein occlusion (CFVO) is frequently found in patients with chronic venous insufficiency. The iatrogenic form, secondary to either central catheter or surgery, is very rare but highly symptomatic. Classical compression therapy barely improves the clinical status of these patients, making them suitable candidates for an interventional procedure for venous recanalization. METHODS We report here three consecutive cases of iatrogenic CFVO referred to our outpatient clinic because the disease had an impact on daily life activities. We detail the recanalization procedure, the Doppler control and the short-term outcome. RESULTS In each case, endovascular recanalization required rigid material (rigid guide or Colapinto needle) to cross the fibrous adhesions before angioplasty could be performed with stenting. The procedure required two attempts in each case, underlining its complexity, but eventually enabled effective recanalization. No major complication occurred per- or post-procedure. One month later, a duplex Doppler control confirmed the permeability of the common femoral vein. The patients had experienced rapid and significant symptom improvement. CONCLUSION Patients suffering from severe chronic venous insufficiency caused by iatrogenic CFVO can benefit from endovascular recanalization. Although these procedures may be complex due to the extensive fibrosis at the Scarpa and require specialized equipment, no major complications were observed. Patency of the recanalization persisted at least one month after the procedure. Symptom relief was good.
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Affiliation(s)
- G Goudot
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France; Inserm U970, PARCC, université Paris Descartes, Sorbonne Paris Cité, 75015 Paris, France
| | - C Del Giudice
- Service de radiologie interventionnelle vasculaire et oncologique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Pellerin
- Service de radiologie interventionnelle vasculaire et oncologique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M C Courtois
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - A Galloula
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - E Messas
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France; Inserm U970, PARCC, université Paris Descartes, Sorbonne Paris Cité, 75015 Paris, France
| | - T Mirault
- Service de médecine vasculaire, hôpital européen Georges-Pompidou, université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France; Inserm U970, PARCC, université Paris Descartes, Sorbonne Paris Cité, 75015 Paris, France
| | - M Sapoval
- Service de radiologie interventionnelle vasculaire et oncologique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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17
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Abstract
Central venous stenosis or occlusion is a common and vexing problem in patients undergoing hemodialysis. Typical presenting symptoms include arm swelling and prolonged bleeding after hemodialysis. Despite multiple treatment approaches, these stenoses tend to recur and progress over time. A thorough preprocedure evaluation, methodical procedural approach and awareness of potential complications are all essential to try to preserve vascular access and improve patients' quality of life.
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Affiliation(s)
- Masahiro Horikawa
- Dotter Interventional Institute, Oregon Health and Science University, Portland, OR
| | - Keith B Quencer
- Division of Interventional Radiology, Department of Radiology, University of California, San Diego, San Diego, CA; Dotter Interventional Institute, Oregon Health and Science University, Portland, OR.
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18
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Khalifa M, Patel NR, Moser S. CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques. Cardiovasc Intervent Radiol 2016; 39:611-5. [PMID: 26486156 DOI: 10.1007/s00270-015-1225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD. METHODS Three successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed. RESULTS No immediate complications were identified. There was resumption of HD in all three patients with a 100% success rate. One patient's HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines. CONCLUSION CT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.
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19
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Salama GR, Farinhas JM, Pasquale DD, Wertenbaker C, Bello JA. Central venous occlusion mimics carotid cavernous fistula: a case report and review of the literature. Clin Imaging 2014; 38:884-7. [PMID: 25128089 DOI: 10.1016/j.clinimag.2014.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/21/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
A patient presented with signs and symptoms of a left carotid cavernous fistula (CCF). Computed tomography angiography confirmed filling of the cavernous sinus in the arterial phase. Cerebral digital subtraction angiography demonstrated no evidence of CCF. The workup, diagnosis, and treatment of this patient are discussed, and the literature is reviewed.
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Affiliation(s)
- Gayle R Salama
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA.
| | - Joaquim M Farinhas
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - David D Pasquale
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - Christian Wertenbaker
- (b)Department of Ophthalmology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - Jacqueline A Bello
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
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