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Boktor I, Ali AE, Almehmi A. Endovascular recanalization for filter-bearing inferior vena cava occlusion in a dialysis patient. Radiol Case Rep 2024; 19:5304-5307. [PMID: 39280742 PMCID: PMC11399780 DOI: 10.1016/j.radcr.2024.08.007] [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: 07/25/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/18/2024] Open
Abstract
Central venous occlusion (CVO) or stenosis (CVS) is a common complication of long-term hemodialysis catheters. Endovascular intervention, primarily balloon angioplasty and occasionally stent placement, is the primary approach for managing CVS/CVO lesions. The presence of a filter within the inferior vena cava (IVC) lumen makes recanalization of the IVC more challenging. Here we present a complex case of a 47-year-old female with end-stage kidney disease (ESKD), systemic lupus erythematosus, and recurrent deep venous thrombosis, necessitating an IVC filter, who became catheter-dependent via the right femoral vein and presented with total IVC occlusion below the filter. The occlusion was managed successfully with sequential angioplasty and stenting of the stenotic lesions. This intervention restored venous flow through the IVC into the right atrium and maintained dialysis access through the catheter. This case underscores the complexity of managing CVS/CVO in dialysis patients, especially with the presence of filters within the vascular dialysis conduit.
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Affiliation(s)
- Ivana Boktor
- George Walton Comprehensive High School, Marietta, GA, USA
| | - Ahmed E Ali
- Internal Medicine Residency Program, Crestwood Medical Center, Huntsville, AL, USA
| | - Ammar Almehmi
- Department of Medicine and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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2
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Paik B, Tee ZH, Masuda Y, Choong AM, Ng JJ. A systematic review of right atrial bypass grafting in the management of central venous occlusive disease in patients undergoing hemodialysis. J Vasc Access 2024; 25:14-26. [PMID: 35531762 DOI: 10.1177/11297298221095320] [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: 10/18/2022] Open
Abstract
INTRODUCTION Central venous occlusive disease (CVOD) is a complication that can occur in patients with end-stage renal disease who are receiving hemodialysis. When CVOD develops, patients often require multiple re-interventions to maintain their dialysis access. CVOD can be treated by various strategies such as balloon angioplasty, stenting, lower limb or extra-anatomical grafts, hybrid grafts or surgical bypasses such as right atrial (RA). In this systematic review, we aim to evaluate the indications, technical aspects, and outcomes after RA bypass grafting for the treatment of CVOD in hemodialysis patients. METHODS A systematic and comprehensive literature search was conducted using various electronic databases. We included articles that reported described and reported outcomes of RA bypass grafting for the treatment of CVOD in hemodialysis patients. A narrative review of the indications and technical aspects of RA bypass grafting was performed. We also pooled and reported the primary patency, secondary patency, postoperative complications, and 30-day mortality of RA bypass grafting. RESULTS A total of 21 studies with 55 patients who underwent RA bypass grafting were included in our systematic review. Follow-up period ranged from 0.5 to 84 months. The mean pooled primary patency and secondary patency of RA bypass grafting were 8.1 ± 4.9 and 21.7 ± 20.1 months, respectively. The incidence of early postoperative complications such as surgical site infection, bleeding, and access thrombosis was 0%, 4%, and 4%, respectively. The overall 30-day mortality was 4%. CONCLUSIONS This systematic review summarizes the patient characteristics, technical features and outcomes of RA bypass grafting in the treatment of hemodialysis-related CVOD. RA bypass grafting may be a viable last-resort option when less invasive or conventional treatment options have been exhausted.
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Affiliation(s)
- Benjamin Paik
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zi Heng Tee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Yoshio Masuda
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Mtl Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
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3
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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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4
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Miciura AL, Napier JA, Aziz A. Hybrid Paraclavicular Decompression for Venous Thoracic Outlet Syndrome with Primary Endovascular Reconstruction. Ann Vasc Surg 2023; 96:335-346. [PMID: 37040840 DOI: 10.1016/j.avsg.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Venous thoracic outlet syndrome (vTOS) is characterized by severe stenosis and potential thrombosis of the axillary-subclavian vein (effort thrombosis) with significant effects on patient mobility, quality of life, and risks associated with possible anticoagulation. Treatment goals are aimed at symptomatic improvement and freedom from recurrent thrombosis. To date, there exist no clear protocols or recommendations on surgical approach that result in optimal outcomes. We highlight our institution's experience with a systematized, paraclavicular approach with intraoperative balloon angioplasty only, if needed. METHODS This was a retrospective case series identifying 33 patients that underwent thoracic outlet decompression for vTOS from 2014 to 2021 via paraclavicular approach at Trinity Health Ann Arbor. Demographics, presenting symptoms, perioperative details, and follow-up details describing symptomatic improvement and imaging surveillance were obtained. RESULTS The average age of our patients was 37 years with the most common presenting symptoms of pain and swelling (91%). The average time from diagnosis to thrombolysis for effort thrombosis was 4 days, with an average time to operative intervention of 46 days. All patients underwent a paraclavicular approach with full first rib resection, anterior and middle scalenectomy, subclavian vein venolysis, and intraoperative venogram. Of these, 20 (61%) underwent endovascular balloon angioplasty, 1 required balloon with stent placement, 13 (39%) required no additional intervention, and no patients required surgical reconstruction of the subclavian-axillary vein. Duplex imaging was used to evaluate recurrence in 26 patients at an average of 6 months postop. Of these, 23 demonstrated complete patency (89%), 1 demonstrated chronic nonocclusive thrombus, and 2 demonstrated chronic occlusive thrombus. Almost all our patients (97%) had moderate or significant improvement of their symptoms. None of our patients required a subsequent operation for recurrence of symptomatic thrombosis. The mode length of anticoagulation use postoperatively was 3 months, with an average use of 4.5 months. CONCLUSIONS A systematized surgical approach of paraclavicular decompression for venous thoracic outlet syndrome with primary endovascular balloon angioplasty carries minimal morbidity with excellent functional results and symptomatic relief.
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Affiliation(s)
- Angela L Miciura
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Jarred A Napier
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI
| | - Abdulhameed Aziz
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI.
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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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Andrawos A, Saeed H, Delaney C. A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access. J Vasc Surg Venous Lymphat Disord 2021; 9:1302-1311. [PMID: 33667742 DOI: 10.1016/j.jvsv.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access. METHODS An extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts. RESULTS There were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients. CONCLUSIONS Although both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required.
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Affiliation(s)
- Alice Andrawos
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia; Department of Medical Imaging, Flinders Medical Centre, Bedford Park, Australia; Department of Medical Imaging, Royal Melbourne Hospital, Melbourne, Australia; University of Edinburgh and Royal College of Surgeons, Edinburgh, Australia.
| | - Hani Saeed
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - Christopher Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford, Australia
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Eguchi D, Honma K. Results of Stenting for Central Venous Occlusions and Stenoses in the Hemodialysis Patients. Ann Vasc Dis 2020; 13:235-239. [PMID: 33384724 PMCID: PMC7751087 DOI: 10.3400/avd.oa.20-00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: We aim to investigate the results of stenting for central venous occlusions and stenoses in the hemodialysis patients. Methods: Twenty-nine cases treated with endovascular recanalization with deployment of bare metal stent (BMS) for central venous occlusions (24 cases) and recurrent stenoses (5 cases) between 2014 and 2018 were retrospectively analyzed. Results of these procedures including success rate, operative time, estimated blood loss, morbidity, primary patency, assisted primary patency and freedom from target-lesion revascularization (TLR) were evaluated. Results: Nine lesions were in brachiocephalic vein (Occlusion/Stenosis: 8/1) and 20 lesions were in subclavian vein (Occlusion/Stenosis: 16/4). Procedural success was 94% (29/31 cases) and operation time/estimated blood loss was 68±39 min/28±54 g. Symptom were relieved or disappeared in all successful cases. Morbidity (extravasation of contrast medium) was 3% (1/29). During the period of observation, 1 stent fracture with occlusion and 1 stent migration to periphery were recognized. 1-year primary patency, freedom from TLR, and assisted primary patency were 40% (median patent time: 256 days), 67% (median patent time: 524 days), and 77%, respectively. Conclusion: Stenting for central venous occlusions and stenoses in the hemodialysis patients is safe and durable treatment option. However, considering its off-label use and potential hazard including vessel rupture, stent migration, and stent fracture, the indication for BMS deployment should be conservative, and interventionist should be well acquainted with prevention and measures to these complications. (This is a translation of Jpn J Vasc Surg 2019; 28: 193–198.)
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Affiliation(s)
| | - Kenichi Honma
- Department of Vascular Surgery, Fukuoka City Hospital
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8
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Vowels TJ, Lu T, Zubair MM, Schwein A, Bismuth J. Evaluating a Novel Telescoping Catheter Set for Treatment of Central Venous Occlusions. Ann Vasc Surg 2020; 72:383-389. [PMID: 32890642 DOI: 10.1016/j.avsg.2020.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Central venous occlusive disease (CVOD) is a prevalent problem in patients with end-stage renal disease (ESRD) and can lead to access malfunction or ligation for symptomatic relief. The purpose of this study is to evaluate the efficacy of the TriForce® Peripheral Crossing Set (Cook Medical), a novel reinforced telescoping catheter set designed to provide additional support for crossing difficult central venous occlusions. METHODS This is a single-center retrospective study from a quaternary referral center. We identified 37 patients over a 17-month period who underwent 56 attempts at endovascular recanalization for the treatment of central venous occlusion. Technical success rates, procedural data, and outcomes were compared between those undergoing recanalization using traditional wire/catheter sets versus the TriForce catheter set. RESULTS Average age was 48 ± 2 years. Comorbidities were similar between the two cohorts and included ESRD (61%), deep venous thrombosis (30%), and May-Thurner syndrome (7%). Forty attempts were made with traditional wire/catheter sets and 16 attempts with the TriForce catheter set to treat 2.1 ± 0.2 and 1.9 ± 0.3 occluded venous segments, respectively (P = 0.74). Technical success rates were significantly higher for the group undergoing recanalization using the TriForce catheter (69% versus 38%, P = 0.04) and 4 patients were successfully recanalized using the TriForce catheter set after a failed attempt with traditional wire/catheter sets. Mean fluoroscopy time and radiation dose were 13 ± 3 min and 14,623 ± 2,775 μGy∗m2 for traditional techniques versus 30 ± 6 min and 30,408 ± 10,433 μGy∗m2 for the novel telescoping catheter set (P = 0.01 and 0.09, respectively). Freedom from reintervention at 1 year was 60% for the TriForce cohort versus 44% for the traditional wire/catheter cohort (P = 0.25). CONCLUSIONS The novel TriForce reinforced telescoping catheter set is a useful adjunct that may improve recanalization rates of CVOD compared with traditional wire/catheter sets.
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Affiliation(s)
- Travis J Vowels
- Division of Vascular and Endovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Tony Lu
- Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston TX
| | - M Mujeeb Zubair
- Division of Vascular and Endovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
| | - Adeline Schwein
- Division of Vascular and Endovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX; The Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jean Bismuth
- Division of Vascular and Endovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
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9
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Gamal WM, Mahmoud MA, Wagdy WM, Monofy AG. Comparative study between brachiobasilic and radiobasilic vascular access for dialysis in chronic renal failure patients. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.23736/s1824-4777.19.01407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Outcomes of venous bypass combined with thoracic outlet decompression for treatment of upper extremity central venous occlusion. J Vasc Surg Venous Lymphat Disord 2019; 7:660-664. [DOI: 10.1016/j.jvsv.2019.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/28/2019] [Indexed: 11/21/2022]
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Wooster M, Fernandez B, Summers KL, Illig KA. Surgical and endovascular central venous reconstruction combined with thoracic outlet decompression in highly symptomatic patients. J Vasc Surg Venous Lymphat Disord 2019; 7:106-112.e3. [DOI: 10.1016/j.jvsv.2018.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 10/27/2022]
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12
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Mansour M, Kamper L, Altenburg A, Haage P. Radiological Central Vein Treatment in Vascular Access. J Vasc Access 2018. [DOI: 10.1177/112972980800900203] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the last decades, the percutaneous interventional approach for the treatment of central venous obstructions (CVO) has become increasingly popular as the treatment of first choice because of its minimal invasiveness and reported success rates. CVOs are caused by a diverse spectrum of diseases which can be broadly categorized into two principal eliciting genera, either benign or malignant obstructions. The large group of benign venous obstructions includes the increasing number of end-stage renal disease patients with vascular access related complications. Due to the invasiveness and complexity of thoracic surgery for benign CVOs, the less invasive percutaneous interventional therapy can generally be considered the preferred treatment option. Initially, the radiological intervention consisted of balloon angioplasty alone, subsequently additional stent placement was applied. This was advocated as either primary placement or secondary in cases of elastic recoil or residual stenosis after percutaneous transluminal angioplasty (PTA). The efficacy of angioplasty of CVO in patients with vascular accesses, either with or without stenting, has been addressed by various studies. Overall, reports indicate an initial technical and clinical success rate above 95% and satisfactory patency rates. However, systematic follow-up and frequent re-interventions are necessary to maintain vascular patency to achieve long-term success.
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Affiliation(s)
- M. Mansour
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - L. Kamper
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - A. Altenburg
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
| | - P. Haage
- Department of Diagnostic and Interventional Radiology, HELIOS Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal - Germany
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13
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Shemesh D, Olsha O, Berelowitz D, Zaghal I, Goldin I, Zigelman C. Intra-operative central vein angioplasty during arteriovenous access creation. J Vasc Access 2018; 6:187-91. [PMID: 16552700 DOI: 10.1177/112972980500600406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Central vein stenosis or occlusion due to prior use of central vein hemodialysis catheters may lead to disabling extremity edema or cause early failure after arteriovenous access construction. Our integrated program for arteriovenous access management enables us to identify these stenoses pre-operatively. We carried out intra-operative angiography and angioplasty during arteriovenous access creation in 3 patients with good immediate and long-term results. Intra-operative endovascular therapy is a new application of peripheral vascular surgery techniques for patients with significant central vein stenosis undergoing access surgery, which exploits the high postoperative flow state to maintain patency after angioplasty. It may also be applicable in situations such as proximal arterial stenosis with anticipated steal syndrome and other conditions that may compromise access patency.
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Affiliation(s)
- D Shemesh
- Hemodialysis Access Unit, Department of Surgery and Vascular Surgery Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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14
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Massara M, De Caridi G, Alberti A, Volpe P, Spinelli F. Symptomatic superior vena cava syndrome in hemodialysis patients: mid-term results of primary stenting. Semin Vasc Surg 2017; 29:186-191. [PMID: 28779785 DOI: 10.1053/j.semvascsurg.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This clinical report details the results of endovascular treatment of symptomatic superior vena cava syndrome due to central vein stenosis or obstruction (CVSO) by stent angioplasty in patients with dialysis-dependent end-stage renal disease. A 3-year retrospective review of two institutional registries identified 25 chronic hemodialysis patients (17 men, 8 women) affected by CVSO who received endovascular treatment. The majority of the patients (n = 19) presented with symptomatic arm, breast, and facial swelling; and 6 patients presented with dialysis-access dysfunction and venous-line hypertension. The etiology of CVSO was before central venous catheter in all but 2 patients. Venography showed 19 cases of stenosis (4 stenoses of superior vena cava, 3 brachiocephalic, 10 subclavian, and 2 axillary veins) and 6 occlusions of the superior vena cava. After percutaneous transluminal angioplasty and primary stent angioplasty, there was an immediate regression of symptoms and arteriovenous fistula preservation in 21 cases; 4 patients received a new arteriovenous fistula after interventional treatment. No procedural major complications or patient deaths occurred. During the follow-up period, we recorded a primary patency rate of 95%, 80%, and 70%, respectively, at 6, 12, and 18 months; and a secondary patency rate of 100%, 95%, and 90%, respectively, at 6, 12, and 18 months. In conclusion, endovascular treatment with primary stenting has proven to be a durable treatment option for hemodialysis patients with CVSO, and this treatment should be considered before dialysis access placement in patients with catheter-induced central vein obstruction.
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Affiliation(s)
- Mafalda Massara
- Vascular Surgery Unit, Bianchi-Melacrino-Morelli Hospital, Via Melacrino 1, Reggio Calabria, Italy; Vascular Surgery Unit, University of Messina, Messina, Italy.
| | | | - Antonino Alberti
- Vascular Surgery Unit, Bianchi-Melacrino-Morelli Hospital, Via Melacrino 1, Reggio Calabria, Italy
| | - Pietro Volpe
- Vascular Surgery Unit, Bianchi-Melacrino-Morelli Hospital, Via Melacrino 1, Reggio Calabria, Italy
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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: 64] [Impact Index Per Article: 8.0] [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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16
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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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17
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Kukita K, Ohira S, Amano I, Naito H, Azuma N, Ikeda K, Kanno Y, Satou T, Sakai S, Sugimoto T, Takemoto Y, Haruguchi H, Minakuchi J, Miyata A, Murotani N, Hirakata H, Tomo T, Akizawa T. 2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis. Ther Apher Dial 2015; 19 Suppl 1:1-39. [PMID: 25817931 DOI: 10.1111/1744-9987.12296] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Surgical Options in the Problematic Arteriovenous Haemodialysis Access. Cardiovasc Intervent Radiol 2015; 38:1405-15. [DOI: 10.1007/s00270-015-1155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/30/2015] [Indexed: 11/27/2022]
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19
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Brachiocephalic vein bypass with sternal reconstruction for symptomatic occlusion. Ann Vasc Surg 2014; 28:1936.e5-8. [PMID: 25108095 DOI: 10.1016/j.avsg.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/15/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022]
Abstract
Complications attributed to central venous stenosis and subsequent thrombosis are increasing in frequency and are most commonly associated with neointimal fibroplasia as well as neoplastic, fibrotic, and traumatic pathologies. We present the successful venous bypass and thoracic wall reconstruction of a 58-year-old female with chronic atypical symptoms secondary to brachiocephalic vein occlusion from congenital thoracic dystrophy.
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20
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Abstract
The most complex patients requiring vascular access are those with bilateral central vein occlusions. Endovascular repair of the central lesions when feasible allow upper extremity use for access. When endovascular repair is not feasible, femoral vein transposition should be the next choice. When lower limb access sites have been exhausted or are contraindicated as in obese patients and in patients with peripheral arterial obstructive disease, a range of extrathoracic "exotic" extra-anatomic access procedures as the necklace cross-chest arteriovenous (AV) grafts, the ipsilateral axillo-axillary loops, the brachial-jugular AV grafts, the axillo-femoral AV grafts or even intra-thoracic ones as the right atrial AV bypasses represent the vascular surgeon's last resort. The selection among those extra-anatomical chest-wall procedures should be based upon each patient's anatomy or patient-specific factors.
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21
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Tordoir JHM. Comments regarding 'Vascular access for haemodialysis in patients with central vein thrombosis'. Eur J Vasc Endovasc Surg 2011; 42:850. [PMID: 21890387 DOI: 10.1016/j.ejvs.2011.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 08/15/2011] [Indexed: 11/25/2022]
Affiliation(s)
- J H M Tordoir
- University Hospital, Department of Surgery, Maastricht, The Netherlands.
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22
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Anaya-Ayala JE, Bellows PH, Ismail N, Cheema ZF, Naoum JJ, Bismuth J, Lumsden AB, Reardon MJ, Davies MG, Peden EK. Surgical Management of Hemodialysis-Related Central Venous Occlusive Disease: A Treatment Algorithm. Ann Vasc Surg 2011; 25:108-19. [DOI: 10.1016/j.avsg.2010.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/11/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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23
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Use of a rosch-uchida needle for recanalization of refractory dialysis-related central vein occlusion. AJR Am J Roentgenol 2010; 194:1352-6. [PMID: 20410425 DOI: 10.2214/ajr.09.3485] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate our experience with the use of a Rösch-Uchida needle technique to recanalize central vein occlusion that cannot be traversed with a guidewire. MATERIALS AND METHODS We retrospectively evaluated 33 recanalization procedures performed with a Rösch-Uchida needle on 20 men and 13 women with central vein occlusion during the period January 1999-December 2008. The occlusions were in the subclavian vein (n = 29) and the brachiocephalic vein (n = 4). A 9- or 10-French Rösch-Uchida introducer sheath was advanced centrally to abut the occlusion. The Rösch-Uchida needle was directed and advanced toward a transfemoral angiographic catheter placed on the central side of the occlusion. After passage of a guidewire through the occlusion, balloon angioplasty and stent insertion were performed. The outcome measures evaluated were technical success rate, primary and secondary patency, and complication rate. RESULTS The mean occlusion length was 1.73 +/- 0.8 cm. The rate of technical success of recanalization was 93.9% (31 of 33 procedures). The 3-, 6-, and 12-month primary patency rates were 43.6%, 24%, and 8%, and the 3-, 6-, and 12-month secondary patency rates were 77.4%, 68.8% and 55.9%. One patient reported shoulder pain lasting 2 weeks, which resolved with conservative treatment. CONCLUSION Use of a Rösch-Uchida needle to recanalize central vein occlusion refractory to a traditional procedure is feasible and safe and can preserve the involved extremity for long-term hemodialysis.
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24
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Long-Term Results of Angioplasty and Stent Placement for Treatment of Central Venous Obstruction in 126 Hemodialysis Patients: A 10-Year Single-Center Experience. AJR Am J Roentgenol 2009; 193:1672-9. [DOI: 10.2214/ajr.09.2654] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Rajan D. Percutaneous Techniques for Central Venous Occlusion. J Vasc Access 2009. [DOI: 10.1177/112972980901000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Subclavian Vein to Right Atrial Appendage Bypass without Sternotomy to Maintain Arteriovenous Access in Patients with Complete Central Vein Occlusion, a New Approach. Ann Vasc Surg 2009; 23:465-8. [DOI: 10.1016/j.avsg.2009.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 01/31/2009] [Indexed: 11/23/2022]
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27
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Ozyer U, Harman A, Aytekin C, Boyvat F, Karakayali F. Application of the AMPLATZER Vascular Plug in Endovascular Occlusion of Dialysis Accesses. Cardiovasc Intervent Radiol 2009; 32:967-73. [DOI: 10.1007/s00270-009-9574-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 03/07/2009] [Accepted: 03/23/2009] [Indexed: 12/20/2022]
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28
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Hollenbeck M, Mickley V, Brunkwall J, Daum H, Haage P, Ranft J, Schindler R, Thon P, Vorwerk D. Gefäßzugang zur Hämodialyse. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11560-009-0281-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Kim YC, Won JY, Choi SY, Ko HK, Lee KH, Lee DY, Kang BC, Kim SJ. Percutaneous treatment of central venous stenosis in hemodialysis patients: long-term outcomes. Cardiovasc Intervent Radiol 2009; 32:271-8. [PMID: 19194745 DOI: 10.1007/s00270-009-9511-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 12/10/2008] [Accepted: 01/08/2009] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and 15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months. Each patient was followed for 14 to 60 months. Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%, respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion, endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference in patency between PTAs and stent placement.
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Affiliation(s)
- Young Chul Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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30
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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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31
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Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008; 48:55S-80S. [PMID: 19000594 DOI: 10.1016/j.jvs.2008.08.067] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 08/09/2008] [Accepted: 08/18/2008] [Indexed: 02/07/2023]
Abstract
English language citations reporting complications of arteriovenous access for hemodialysis are critically reviewed and discussed. Venous hypertension, arterial steal syndrome, and high-output cardiac failure occur as a result of hemodynamic alterations potentiated by access flow. Uremic and diabetic neuropathies are common but may obfuscate recognition of potentially correctable problems such as compression or ischemic neuropathy. Mechanical complications include pseudoaneurysm, which may develop from a puncture hematoma, degeneration of the wall, or infection. Dysfunctional hemostasis, hemorrhage, noninfectious fluid collections, and access-related infections are, in part, manifestations of the adverse effects of uremia on the function of circulating hematologic elements. Impaired erythropoiesis is successfully managed with hormonal stimulation; perhaps, similar therapies can be devised to reverse platelet and leukocyte dysfunction and reduce bleeding and infectious complications.
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Affiliation(s)
- Frank T Padberg
- Department of Surgery, Section of Vascular Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
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32
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Surgical Bypass of Symptomatic Central Venous Obstruction for Arteriovenous Fistula Salvage in Hemodialysis Patients. Ann Vasc Surg 2008; 22:203-9. [DOI: 10.1016/j.avsg.2007.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 10/27/2007] [Accepted: 11/02/2007] [Indexed: 11/22/2022]
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33
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Antoniou GA, Georgiadis GS, Souftas VD, Deftereos SP, Lazarides MK. Reversal of Deep Vein Reflux After Successful Stenting in a Patient With Venous Hypertension After Thigh Access Graft Creation. Vasc Endovascular Surg 2008; 41:547-50. [DOI: 10.1177/1538574407305459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Presented here is a case of reversal of deep vein reflux after successful stenting in a patient with venous hypertension and valve incompetence after thigh angioaccess creation. The patient with exhausted upper-extremity access sites underwent a loop graft in the upper thigh. Six months later, the patient developed leg edema and significant femoral vein reflux on duplex ultrasound. Fistulography revealed an iliac vein stenosis, which was treated successfully with stenting. The edema and reflux on duplex promptly resolved. In similar cases, reflux may be a consequence of functional valve incompetence and can be reverted by timely treating the underlying stenosis.
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Affiliation(s)
- George A. Antoniou
- Department of Vascular Surgery, Demokritos University Hospital, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, Demokritos University Hospital, Alexandroupolis, Greece
| | - Vasilios D. Souftas
- Department of Radiology Demokritos University Hospital, Alexandroupolis, Greece
| | - Savas P. Deftereos
- Department of Radiology Demokritos University Hospital, Alexandroupolis, Greece
| | - Miltos K. Lazarides
- Department of Vascular Surgery, Demokritos University Hospital, Alexandroupolis, Greece, mlazarid @med.duth.gr
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34
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Murasato Y, Tsurugi T, Hiroshige K, Kamezaki F, Suzuka H, Kawanami K, Suzuki Y. Percutaneous stenting of bilateral central venous occlusions in a hemodialysis patient. Heart Vessels 2007; 22:193-8. [PMID: 17533524 DOI: 10.1007/s00380-006-0936-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 07/12/2006] [Indexed: 11/30/2022]
Abstract
Upper-extremity central venous obstruction is often first recognized when an arteriovenous fistula is made for hemodialysis at an ipsilateral site. We encountered a case of markedly expanded edema after making an arteriovenous fistula in the left forearm. Systemic venography showed that the bilateral brachiocephalic veins and right subclavian vein were occluded. Implantation of a self-expandable stent in the left brachiocephalic vein relieved the edema. However, recurrence of similar edema and occlusion of the left brachiocephalic vein were noted after 1.5 years. The left brachiocephalic vein was then recanalized by ballooning and additional stent implantation, and a stent was implanted between the superior vena cava and right subclavian vein. Simultaneous reconstruction of the bilateral central venous obstruction by percutaneous intervention rather than surgical repair was suitable for this patient because of previous thoracoplasty. We also believe that this method can provide an opportunity to select the suitable forearm for making an arteriovenous fistula, in which the ipsilateral central vein will exhibit little restenosis.
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Affiliation(s)
- Yoshinobu Murasato
- Division of Cardiovascular Medicine, Chikuho Social Insurance Hospital, 765-1 Yamabe, Nogata, 822-0034, Japan.
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35
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Abstract
Central vein stenosis is commonly associated with placement of central venous catheters and devices. Central vein stenosis can jeopardize the future of arteriovenous fistula and arteriovenous graft in the ipsilateral extremity. Occurrence of central vein stenosis in association with indwelling intravascular devices including short-term, small-diameter catheters such as peripherally inserted central catheters, long-term hemodialysis catheters, as well as pacemaker wires, has been recognized for over two decades. Placement of multiple catheters, longer duration, location in subclavian vein, and placement on the left-hand side of neck seem to predispose to the development of central vein stenosis. Endothelial injury with subsequent changes in the vessel wall results in development of microthrombi, smooth muscle proliferation, and central vein stenosis. Central vein stenosis is often asymptomatic in nondialysis patients, but can result in edema of ipsilateral extremity and breast when challenged by increased flow from an arteriovenous fistula or arteriovenous graft. Bilateral central vein stenosis or superior vena cava stenosis can produce a clinical picture of superior vena cava syndrome, associated with engorgement of face and neck. Endovascular interventions are the mainstay of management of central vein stenosis. Percutaneous angioplasty and stent placement for elastic and recurring lesions can restore the functionality of the vascular access, at least temporarily. Frequent or multiple interventions are usually required. In recalcitrant cases, surgical bypass of the obstruction is an option. In resistant cases with severe symptoms, occlusion of the functioning vascular access will usually provide relief of symptoms. Further study of mechanisms of development of central vein stenosis and search for a targeted therapy is likely to lead to better ways of managing central vein stenosis. Prevention of central vein stenosis is the key to avoid access failure and other complications from central vein stenosis and relies upon avoidance of central vein stenosis placement and timely placement of arteriovenous fistula in prospective dialysis patient.
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Affiliation(s)
- Anil K Agarwal
- Division of Nephrology, Department of Internal Medicine, Ohio State University, Columbus, Ohio 43210, USA.
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36
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Amano I, Ohira S, Goto Y, Hino I, Ikeda K, Kukita K, Haruguchi H. In Preparation for a Treatment Guideline for Suitable Vascular Access Repair in Japan. Ther Apher Dial 2006; 10:364-71. [PMID: 16911190 DOI: 10.1111/j.1744-9987.2006.00390.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In cases of vascular access (VA) for hemodialysis including arteriovenous fistula and arteriovenous graft, venipuncture and hemostasis are usually repeated three times a week. Accordingly, it is assumed that VA vascular disorders are worsened following long-term hemodialysis. In particular, angiostenosis frequently occurs and results in insufficient blood flow or increased venous pressure. Additionally, stenosis is a major cause of VA occlusion. While VA intervention treatment is mainstream for VA stenosis, its major advantage lies in its less invasiveness because it is a percutaneous treatment. A further advantage of this treatment procedure is that the existing VA can be preserved intact. For practical use of VA intervention treatment, however, compliance with the therapeutic indication guideline is required. In K/DOQI of the United States, such a guideline has already been formulated based on evidence and specialist opinion, while the guideline of the European Vascular Access Society is presented in the form of a flowchart. The Japanese Society for Dialysis Therapy is currently preparing a guideline for the construction and maintenance of VA, which introduces the timing and principles of repair of VA in the following six categories: (i) stenosis; (ii) occlusion; (iii) venous hypertension; (iv) steal syndrome; (v) excess blood flow; and (vi) infection. Except for infection, most of the treatments for these events involve VA intervention, thus the need for the guideline for VA intervention treatment is becoming widely recognized.
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Affiliation(s)
- Izumi Amano
- Division of Nephrology and Blood Purification, Tenri Hospital, Nara, Japan.
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Haage P, Günther RW. Radiological Intervention to Maintain Vascular Access. Eur J Vasc Endovasc Surg 2006; 32:84-9. [PMID: 16297644 DOI: 10.1016/j.ejvs.2005.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 10/07/2005] [Indexed: 11/20/2022]
Abstract
Stenoses and thromboses of dialysis grafts and fistulae are common problems in patients with end stage renal disease (ESRD). Timely recognition and treatment of access-related complications are essential to achieve long-term access function. Minimally invasive percutaneous interventions are techniques of growing importance for the interventional community. While stenoses can typically be treated by balloon angioplasty (PTA), thrombotic lesions may necessitate the combination of mechanical devices and/or thrombolytic agents with ancillary PTA. In this article, interventional treatments for the failing arteriovenous (AV) access are presented and reviewed.
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Affiliation(s)
- P Haage
- Department of Diagnostic Radiology, RWTH Aachen University, Pauwelsstrasse 30, D-52057 Aachen, Germany.
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38
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Christidou FP, Kalpakidis VI, Iatrou KD, Zervidis IA, Bamichas GI, Gionanlis LC, Natse TA, Sombolos KJ. Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion. Radiography (Lond) 2006. [DOI: 10.1016/j.radi.2005.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Tratamiento endovascular de estenosis venosas del acceso vascular para hemodiálisis. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)75008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Gil CC, Azevedo FV, Ferreira MA. A Successful Struggle to Prolong Arteriovenous Fistula Patency: A Case Report. J Vasc Access 2005; 6:34-7. [PMID: 16552681 DOI: 10.1177/112972980500600108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An adequate vascular access (VA) significantly determines the morbidity and mortality of chronic renal failure (CRF) patients on maintenance hemodialysis (HD). VA patency depends on the early identification of complications and its management by the nephrologists and vascular surgeon. Venous stenosis accounts for the majority of thromboses, but its early detection followed by either percutaneous angioplasty (PTA) and/or surgical correction will improve fistula patency. We present the clinical case report of a 90-year-old patient with recurrent central venous stenosis after PTA that was corrected with bypass surgery. Two years after surgery the original fistula is still used showing no signs of access dysfunction.
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Affiliation(s)
- C C Gil
- Hemodial, Vila Franca de Xira Hemodialysis Center, Portugal.
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41
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Kavallieratos N, Kokkinos A, Kalocheretis P. Axillary to saphenous vein bypass for treatment of central venous obstruction in patients receiving dialysis. J Vasc Surg 2004; 40:640-3. [PMID: 15472589 DOI: 10.1016/j.jvs.2004.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Venous hypertension due to subclavian or innominate vein stenosis coexisting with a functioning arteriovenous access in the ipsilateral arm is a complex problem in patients undergoing hemodialysis. Therapeutic solutions must optimally relieve symptoms, permit use of the angioaccess, and carry minimal surgical risk. The purpose of this study was to evaluate a simple surgical option, bypassing central venous obstruction to the great saphenous vein. METHODS Eight patients undergoing hemodialysis with severe symptoms and signs of venous hypertension due to subclavian or innominate vein obstruction and ipsilateral arteriovenous fistula or graft underwent axillosaphenous bypass via a subcutaneous 8-mm polytetrafluoroethylene bridge graft. RESULTS No intraoperative or immediate postoperative morbidity was observed. Early and 6-month patency rates were 100% and 87.5%, respectively. All patients reported improvement of symptoms, and the angioaccess was usable in all cases. Average follow-up was 21.5 months. One patient had a relapse at 5 months, which necessitated revision of the graft-saphenous vein anastomosis. CONCLUSION Bypassing a central vein occlusion to the saphenous vein relieves symptoms of venous hypertension and prolongs use of the hemodialysis angioaccess.
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Sprouse LR, Lesar CJ, Meier GH, Parent FN, Demasi RJ, Gayle RG, Marcinzyck MJ, Glickman MH, Shah RM, McEnroe CS, Fogle MA, Stokes GK, Colonna JO. Percutaneous treatment of symptomatic central venous stenosis angioplasty. J Vasc Surg 2004; 39:578-82. [PMID: 14981452 DOI: 10.1016/j.jvs.2003.09.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The increased use of central venous access primarily for hemodialysis has led to a significant increase in clinically relevant central venous occlusive disease (CVOD). The magnitude of and the optimal therapy for CVOD are not clearly established. The purpose of this study is to define the problem of CVOD and determine the success of percutaneous therapy for relieving symptoms and maintaining central venous patency. METHODS Patients presenting with disabling upper-extremity edema suggestive of central venous stenosis or occlusion during a 3-year period were evaluated by venography of the upper extremity and central veins. Percutaneous venous angioplasty (PTA) and/or stent placement was performed as clinically indicated. The success of therapy was assessed, and the patients were observed to determine the incidence of recurrence and additional procedures. Recurrent lesions underwent similar evaluation and treatment. RESULTS A total of 32 sides were treated in 29 patients with a mean of 1.9 interventions per side treated. Hemodialysis-related lesions were the underlying cause in 87% with the remaining 13% related to previous central venous catheterization. The lesions involved the axillary, subclavian, and innominate veins with complete venous occlusion in six (19%) cases. Percutaneous angioplasty was followed by stent placement in six (19%) cases. The procedure was a technical success and was performed without complications in all cases (100%). Mean follow-up was 16.5 months (range, 4-36 months). On average, patient symptoms were controlled for 6.5 months after the initial intervention. Recurrent edema led to additional PTA in 20 (63%) cases. Fifty percent (n = 14) of patients with an arteriovenous fistula (AVF) experienced recurrent symptoms after initial and/or repeat PTA and required AVF ligation. Complete resolution after the initial PTA was predictive of long-term success. CONCLUSIONS Central venous occlusive disease has emerged as a significant clinical problem. Percutaneous venous angioplasty can provide temporary symptomatic relief; however, multiple procedures are often required and long-term relief is rarely achieved.
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Affiliation(s)
- L Richard Sprouse
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA 23510, USA.
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Neville RF, Abularrage CJ, White PW, Sidawy AN. Venous hypertension associated with arteriovenous hemodialysis access. Semin Vasc Surg 2004; 17:50-6. [PMID: 15011180 DOI: 10.1053/j.semvascsurg.2003.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous hypertension is a significant problem for the patient on chronic hemodialysis. This condition can result in impairment of arteriovenous access function, disabling upper extremity edema with bluish discoloration and pigmentation of the skin, and, in advanced cases, ulceration of the finger tips and neuralgias. Venous hypertension usually results from central vein stenosis or valvular incompetence in the arteriovenous access outflow vein. A high index of suspicion is required to identify patients at risk for venous hypertension. A history of ipsilateral central venous catheter placement, or physical signs such as visible distended shoulder venous collaterals, and upper extremity edema are suggestive. Diagnosis is confirmed with Duplex ultrasound or contrast venography. The primary goal of diagnosis and therapy of venous hypertension is symptomatic relief while maintaining the functionality of the access. Treatment includes percutaneous catheter-based and open surgical techniques. Open surgical techniques, while more invasive, remain the gold standard as long-term patency after angioplasty, with or without covered stents, remains unproven.
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Dammers R, de Haan MW, Planken NR, van der Sande FM, Tordoir JH. Central vein obstruction in hemodialysis patients: Results of radiological and surgical intervention. Eur J Vasc Endovasc Surg 2003; 26:317-21. [PMID: 14509897 DOI: 10.1053/ejvs.2002.1943] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIMS Symptomatic central venosus obstruction (CVO) in dialysis patients with arteriovenous fistulas (AVFs) leads to significant morbidity and patient inconvenience. We evaluated the results of surgical and radiological interventional treatment of symptomatic central venous obstruction. METHODS Clinical data, site and length of vein obstruction, type and outcome of intervention were obtained from patient records. Patency rates of radiological and surgical treatment were calculated using Life Table survival analysis. RESULTS In 28 patients with VH, 45 interventions (percutaneous intervention 30; surgical reconstruction 10; AVF closure five) were performed. Mean vessel obstruction length was 4.9 cm, mainly localized in the subclavian vein (55%). Initial clinical success rate of PTA and surgery was 92%, with complications after percutaneous transluminal angioplasty (PTA) on six occasions. Restenosis after PTA was observed in 39%. One-year primary and secondary patency after PTA was 50 and 63%, respectively. One-year primary patency after surgical reconstruction was 75%. CONCLUSION Symptomatic CVO in dialysis patients with AVFs can be treated with a high success rate through radiological intervention. Surgical reconstruction is an appropriate alternative method in case of failed PTA.
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Affiliation(s)
- R Dammers
- Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
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Chandler NM, Mistry BM, Garvin PJ. Surgical bypass for subclavian vein occlusion in hemodialysis patients. J Am Coll Surg 2002; 194:416-21. [PMID: 11949747 DOI: 10.1016/s1072-7515(02)01127-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The majority of patients with end-stage renal disease are dependent on hemodialysis. Significant stenosis or occlusion of the subclavian vein is known to occur in 20% to 50% of patients who have had central venous catheters inserted into the subclavian vein or the internal jugular vein. Surgical bypass of the obstructed venous segment proximal to a functioning dialysis access site is an established treatment to relieve symptoms and salvage the functional dialysis access. STUDY DESIGN A retrospective review of all subclavian venous bypass procedures performed at St Louis University Hospital from May 1987 to May 2000 was undertaken. Twelve procedures were performed during this time. The mean age of the patient was 55.5 years (range 17 to 72 years). There were 11 men and 1 woman. Before surgical bypass, all patients underwent bilateral venograms to evaluate their central venous systems. RESULTS An extraanatomic surgical bypass was performed in all patients. Patients were followed for a mean of 16 months (range 1 to 79 months). At 1 month, 100% of hemodialysis access sites remained functional. At 1 year, 80%; 2 years, 60%; and 3 years, 25% of the salvaged arteriovenous hemodialysis access sites provided for functional dialysis. One patient required thrombectomy of the bypass graft at 14 months. CONCLUSIONS Surgical bypass of an occluded or stenotic subclavian vein segment is successful in providing both symptomatic relief and salvage of a functioning dialysis access in the hemodialysis patient population. Study of the central venous system is essential in selecting an appropriate bypass procedure in individual patients.
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Affiliation(s)
- Nicole M Chandler
- Department of Surgery, St Louis University Health Sciences Center, MO, USA
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Oderich GS, Treiman GS, Schneider P, Bhirangi K. Stent placement for treatment of central and peripheral venous obstruction: a long-term multi-institutional experience. J Vasc Surg 2000; 32:760-9. [PMID: 11013040 DOI: 10.1067/mva.2000.107988] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The clinical success and patency of central and peripheral venous stents in patients with symptomatic venous obstruction (SVO) were assessed. METHODS The records of patients with SVO treated with venous stents from 1992 to 1999 were reviewed. Demographic and procedural variables were analyzed to determine their effect on clinical success, primary patency, and secondary patency. Patency was determined by means of a follow-up duplex scan or venogram. RESULTS Forty central venous (CV) and 14 peripheral venous (PV) obstructions were treated in 49 patients. Sixty-five stents were placed (50 CV and 15 PV), 54 in previously unstented lesions and 11 in previously stented lesions. Causes of CV lesions included catheter placement (82%), tumor compression (6%), arteriovenous fistula (AVF) and no prior catheter (2%), and other (10%). All PV lesions resulted from complications of dialysis. Indications for CV stents included limb edema (46%), AVF malfunction (30%), both limb edema and AVF malfunction (14%), and other (10%). PV stent indications were AVF malfunction (86%) and limb edema (14%). Thirteen CV stents indicated to treat tumor compression (three cases), May-Thurner syndrome (one case), deep venous thrombosis (three cases), superior vena cava syndrome (one case), and lower-extremity catheter-related lesions (five cases) were excluded from the analysis of clinical outcome. Fifty-two stents (37 CV and 15 PV) were included in the analysis of clinical outcome. All CV lesions included in the analysis were complications of prolonged catheterization. Eighty-nine percent of patients had end-stage renal disease and an AVF. Complications developed in 26% of patients with PV stents and in no patients with CV stents (P <.002). The mean follow-up period was 16 months. Sixty-two percent of patients required a reintervention for recurrent SVO. Only 32% of the interventions resulted in sustained symptomatic improvement. For CV stents, the primary patency rate was 85%, 27%, and 9% at 3, 12, and 24 months, respectively; the secondary patency rate was 91%, 71%, and 39% at 3, 12, and 24 months, respectively; and the clinical success rate was 94%, 94%, and 79%, at 3, 12, and 24 months, respectively. For PV stents, the primary patency rate was 73%, 17% and 17% at 3, 12, and 24 months, respectively; the secondary patency rate was 80%, 56%, and 35% at 3, 12, and 24 months, respectively; and the clinical success rate was 92%, 75%, and 42% at 3, 12 and 24 months, respectively. CONCLUSION Stents provide a temporary benefit in most patients with central or peripheral upper-extremity SVO. Regular follow-up and reinterventions are required to maintain patency and achieve long-term clinical success. Stents used for CV lesions have higher clinical success rates than stents used for PV lesions. Patients with a reasonable life expectancy or who are unable to return for subsequent procedures should be considered for undergoing alternative therapy.
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Affiliation(s)
- G S Oderich
- Division of Vascular Surgery, University of Utah School of Medicine, USA
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Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther RW. Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary Wallstent placement and follow-up in 50 patients. Radiology 1999; 212:175-80. [PMID: 10405739 DOI: 10.1148/radiology.212.1.r99jl21175] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze the effectiveness of stent placement as the primary treatment for central venous obstruction in patients undergoing hemodialysis. MATERIAL AND METHODS Fifty-seven Wallstents were placed in 50 patients with symptomatic shunt dysfunction and arm swelling due to central venous obstruction. Technical success, complication, and patency rates were evaluated. RESULTS Stent deployment was successful in all patients, and early rethrombosis (within 1 week) was noted in one patient (2%). Seventy-three episodes of reobstruction occurred and were treated percutaneously with angioplasty alone in 54 cases (74%). Nineteen cases (26%) necessitated additional stent placement. The 3-, 6-, 12-, and 24-month primary patency rates were 92%, 84%, 56%, and 28%, respectively. Cumulative overall stent patency was 97% after 6 and 12 months, 89% after 24 months, and 81% after 36 and 48 months. CONCLUSION In the treatment of brachiocephalic and subclavian venous obstruction, stent placement shows excellent technical results and helps preserve vascular access for a substantial period. Multiple repeat interventions are, however, frequently required to maintain patency.
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Affiliation(s)
- P Haage
- Department of Diagnostic Radiology, University of Technology, Aachen, Germany.
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Petersen BD, Uchida BT. Long-term results of treatment of benign central venous obstructions unrelated to dialysis with expandable Z stents. J Vasc Interv Radiol 1999; 10:757-66. [PMID: 10392944 DOI: 10.1016/s1051-0443(99)70111-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate long-term patency of self-expanding Z stents for treatment of benign central venous obstructions unrelated to dialysis. MATERIALS AND METHODS Z stents were placed in 19 patients, (ages 26-72 years) with severe symptomatic obstructions of the superior or inferior venae cavae and their large branches and portal vein caused by surgical or catheter injury (n = 8), fibrosis (n = 5), cirrhosis (n = 3), Budd-Chiari syndrome (n = 2), and extrinsic compression (n = 1). Fourteen patients underwent stent placement primarily, five after local urokinase infusion for superimposed thrombosis. Follow-up was performed with ultrasound and venography. RESULTS Venous congestive symptoms quickly resolved in all patients after stent placement. The follow-up period was from 1 to 94 months. Twelve patients have died during follow-up from 1 to 37 months although all remained asymptomatic until death. Six patients remain alive, asymptomatic, with patent stents, and with follow-up from 24 to 94 months. Primary patency was 83%, and secondary patency was 100%. One patient with a patent stent at 12 months was lost to follow-up. No stent migrations, perforations, infections, or significant complications occurred. CONCLUSION Benign central venous obstructions are effectively treated by the placement of self-expandable Z stents. Placed percutaneously into obstructive lesions with a minimum risk, these stents offer long-term durability and patency.
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Affiliation(s)
- B D Petersen
- Dotter Interventional Institute, Portland, OR 97201-3098, USA
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El-Sabrout RA, Duncan JM. Right atrial bypass grafting for central venous obstruction associated with dialysis access: another treatment option. J Vasc Surg 1999; 29:472-8. [PMID: 10069911 DOI: 10.1016/s0741-5214(99)70275-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Central venous obstruction is a common problem in patients with chronic renal failure who undergo maintenance hemodialysis. We studied the use of right atrial bypass grafting in nine cases of central venous obstruction associated with upper extremity venous hypertension. To better understand the options for managing this condition, we discuss the roles of surgery and percutaneous transluminal angioplasty with stent placement. METHODS All patients had previously undergone placement of bilateral temporary subclavian vein dialysis catheters. Severe arm swelling, graft thrombosis, or graft malfunction developed because of central venous stenosis or obstruction in the absence of alternative access sites. A large-diameter (10 to 16 mm) externally reinforced polytetrafluoroethylene (GoreTex) graft was used to bypass the obstructed vein and was anastomosed to the right atrial appendage. This technique was used to bypass six lesions in the subclavian vein, two lesions at the innominate vein/superior vena caval junction, and one lesion in the distal axillary vein. RESULTS All patients except one had significant resolution of symptoms without operative mortality. Bypass grafts remained patent, allowing the arteriovenous grafts to provide functional access for 1.5 to 52 months (mean, 15.4 months) after surgery. CONCLUSION Because no mortality directly resulted from the procedure and the morbidity rate was acceptable, this bypass grafting technique was adequate in maintaining the dialysis access needed by these patients. Because of the magnitude of the procedure, we recommend it only for the occasional patient in whom all other access sites are exhausted and in whom percutaneous dilation and/or stenting has failed.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anastomosis, Surgical
- Arm/blood supply
- Arteriovenous Shunt, Surgical/adverse effects
- Arteriovenous Shunt, Surgical/instrumentation
- Axillary Vein/surgery
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
- Brachiocephalic Veins/surgery
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheters, Indwelling/adverse effects
- Female
- Graft Occlusion, Vascular/etiology
- Graft Survival
- Heart Atria/surgery
- Humans
- Hypertension/surgery
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Polytetrafluoroethylene
- Renal Dialysis/adverse effects
- Renal Dialysis/instrumentation
- Retrospective Studies
- Subclavian Vein/surgery
- Vascular Patency
- Vena Cava, Superior/surgery
- Venous Thrombosis/etiology
- Venous Thrombosis/surgery
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Affiliation(s)
- R A El-Sabrout
- Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, USA
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Abstract
PURPOSE To describe a sharp puncture technique for recanalization of chronic central venous occlusions that could not be traversed by a guide wire. MATERIALS AND METHODS Five patients presented with six longstanding central venous occlusions that could not be traversed with a guide wire after thrombolysis. The occlusions occurred following radiation for lung carcinoma (n = 2) and indwelling venous catheters (n = 4). The length of venous occlusion was determined by simultaneously advancing transbrachial and transfemoral catheters to the site of occlusion. Initially, a curved guiding catheter with a Rosch-Uchida needle and, in subsequent patients, a coaxial sheathed needle with a 21-gauge stylet were used for recanalization. The recanalized veins were then balloon dilated and stents were placed. RESULTS With use of this technique, recanalization was successful in five of the six occlusions. One occlusion was too long to traverse safely in one patient. Two patients were asymptomatic 16-18 months after the recanalization. CONCLUSION This new technique offers an effective alternative to surgery in the treatment of central venous occlusion.
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Affiliation(s)
- T Farrell
- Department of Radiology, University of Iowa College of Medicine, Iowa City, USA
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