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Liu Z, Huang J, Tang Y, Huo G, Cao J, Yao Z, Zeng Y, Shen L, Zhou D. Outcomes of stent grafts for treatment of central venous disease in hemodialysis patients. J Vasc Access 2024; 25:813-820. [PMID: 36324210 DOI: 10.1177/11297298221134142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND To evaluate the effectiveness of stent graft (SG) for the treatment of central venous disease (CVD) in hemodialysis patients. METHODS Between January 2014 and April 2022, 122 patients on hemodialysis with symptomatic CVD were treated with percutaneous transluminal angioplasty (PTA) and bare-metal stent (BMS) or SG placement. The mean follow-up was 14.5 months (IQR: 8.0, 24.2). Patency rates of the target sites were calculated using Kaplan-Meier and log-rank studies. Multivariate Cox proportional hazard models were used to evaluate the association between various characteristics and target site primary patency. RESULTS Technical success rate was 100%. At 3, 6, 12, and 24 months, the target sites primary patency rates were 86.4%, 74.2%, 45.1%, and 30.4% for PTA; 94.7%, 78.6%, 60.8%, and 45.6% for BMS; and 94.0%, 92.0%, 82.4%, and 66.8% for SG, respectively, and the assisted primary patency rates were 86.5%, 80.4%, 63.8%, and 46.0% for PTA; 94.7%, 89.5%, 77.5%, and 71.1% for BMS; 100%, 100%, 97.8%, and 83.4% for SG, respectively. The Kaplan-Meier analysis indicated that SGs achieved better primary and assisted primary patency than PTA or BMS (p<0.05). SG use and concomitant stenosis were the independent predictors of target site primary patency dysfunction in the multivariate analysis. CONCLUSIONS This study confirmed the better long-term patency of SG in comparison with PTA and BMS for the treatment of CVD in hemodialysis patients.
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Affiliation(s)
- Zhanao Liu
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jian Huang
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yao Tang
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Guijun Huo
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Junjie Cao
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhichao Yao
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yuqi Zeng
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Liming Shen
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Dayong Zhou
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
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Seo KW, Park JS. Migration of central vein stent into the right atrium. Korean J Intern Med 2024; 39:364-365. [PMID: 37946450 PMCID: PMC10918383 DOI: 10.3904/kjim.2023.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Kyoung-Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
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Liu Z, Zhang J, Huang J, Yao Z, Shen L, Zhou D. Small Oversized Stent Graft Is Associated With Increased Patency for the Treatment of Central Venous Disease in Hemodialysis Patients. J Endovasc Ther 2024:15266028241232921. [PMID: 38361403 DOI: 10.1177/15266028241232921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE The purpose of this study was to identify the independent predictors of higher patency rates and investigate the selection of specifications of stent graft in the treatment of central venous disease. MATERIALS AND METHODS This retrospective study included 54 patients who underwent stent-grafts' placement for the treatment of central venous disease between March 2017 and September 2022 at a tertiary hospital. The demographic data for the patients and the clinical data of the treated lesions were collected and analyzed. The patency rates of the treated lesions with different oversizing range were calculated via the Kaplan-Meier and log-rank analyses. The multivariate Cox proportional hazard models were constructed to identify the independent predictor of the target site primary patency. RESULTS The median follow-up period was 21.5 months. The primary patency rates of the target sites were 90.7%, 72.2%, and 55.1% at 6, 12, and 24 months, respectively. The assisted primary patency rates of the lesions were 96.3%, 92.5%, and 80.3% at 6, 12, and 24 months, respectively. The log-rank analysis showed that the stent-grafts' placement with small oversizing had significantly higher primary patency rates than those with large oversizing (p=0.022). The multivariate analysis revealed that concomitant stenosis and large oversizing stent graft were the independent predictors of target site primary patency. CONCLUSIONS Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing. CLINICAL IMPACT Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. Few studies, however, have explored the efficiency of stent grafts to treat CVD by considering different factors such as sizing considerations, the rate of oversizing percentage, etc. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing. Excessive oversizing should be avoided to prevent infolding or stent collapse.
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Affiliation(s)
- Zhanao Liu
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Jinru Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Huang
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhichao Yao
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Liming Shen
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Dayong Zhou
- Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
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Ghasemi-Rad M, Do L, Collard M, Cui J, Irani Z. The Use of Viatorr Stent at the Thoracic Outlet to Maintain Hemodialysis Access Function. Vasc Endovascular Surg 2023; 57:901-904. [PMID: 37310358 PMCID: PMC10543124 DOI: 10.1177/15385744231183490] [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: 06/14/2023]
Abstract
PURPOSE Venous steno-occlusive disease at the thoracic outlet affects up to 30% of the hemodialysis population [1] causing arm swelling and hemodialysis access dysfunction. Balloon angioplasty in this region can be of limited utility given the rigid compressive effect of surrounding musculoskeletal (MSK) structures. Outcomes of using the Viatorr endoprosthesis (Gore Viatorr TIPS Endoprosthesis, Gore, Flagstaff AR, USA, Viatorr ®) within this region to salvage the HD access in patients who presented with dialysis access dysfunction is presented. METHODS A retrospective chart review was performed of our tertiary and quaternary care hospital system. Hemodialysis patients were included in the study if they were using an upper extremity arteriovenous fistula or graft for access, had a Viatorr stent placed in the central (subclavian and/or brachiocephalic) veins, and had follow up. RESULTS A total of nine patients were identified to meet the inclusion criteria. Four interventions were due to refractory lesions of the subclavian or brachiocephalic veins, and the other five interventions were for hemodynamically significant lesions refractory to angioplasty alone, all resulting in access dysfunction. Primary patency ranged from 36-442 days (geometric mean 156.6 days, range 19-442 days). No stent fracture was identified on imaging at any point during follow-up of these patients out to a maximum of 2912 days (Average 837 days). CONCLUSIONS The Viatorr stent graft used in the HD population for clinically significant lesions at the thoracic outlet (TO) showed no structural failures (fractures) in this cohort.
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Affiliation(s)
- Mohammad Ghasemi-Rad
- Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Lauren Do
- MD candidate, Baylor College of Medicine, Houston, TX, USA
| | - Michael Collard
- Department of Radiology, Section of Vascular and Interventional Radiology, Johns Hopkins All Childrens Hospital, St Petersburg, FL
| | - Jai Cui
- Department of Radiology, Section of Vascular and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zubin Irani
- Department of Radiology, Section of Vascular and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chen B, Lin R, Dai H, Yang J, Tang K, Li N, Huang Y. One-year outcomes and predictive factors for primary patency after stent placement for treatment of central venous occlusive disease in hemodialysis patients. Ther Adv Chronic Dis 2022; 13:20406223211063039. [PMID: 35198135 PMCID: PMC8859657 DOI: 10.1177/20406223211063039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The study purpose was to determine the outcomes and factors predictive of primary stent patency for the treatment of central venous occlusive disease (CVOD) in hemodialysis patients. Methods: Data of 71 patients with CVOD treated with stent placement from January 2012 to December 2017 were analyzed. Univariate and multivariate analysis was performed to determine factors associated with stent patency. Adverse events related to stent placement were also examined. Results: The median primary patency duration of the 71 patients was 16 ± 2.2 months. The cumulative 3-, 6-, 9-, and 12- month primary patency rates were 93%, 72%, 55%, and 51%, respectively. Independent predictors of longer primary patency were vessel diameter > 12 mm, the use of a covered stent, and absence of vessel calcifications. Median primary patency of covered stents was 21 months as compared with only 10 months for bare stents (p < 0.001). Procedure-related adverse events occurred in 17 patients (21.8%), and four events (5.1%) required medical intervention. No life-threaten complications occurred. Conclusions: A vessel diameter > 12 mm, the use of a covered stent, and no vessel calcifications are independently associated with a higher primary patency rate after treatment of CVOD in hemodialysis patients.
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Affiliation(s)
- Bin Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Run Lin
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haitao Dai
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianyong Yang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Keyu Tang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nan Li
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonghui Huang
- The First Affiliated Hospital, Sun Yat-sen University, NO. 58 Zhong Shan Er Lu, Guangzhou, Guangdong 510080, P.R. China
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L McDevitt J, T Goldman D, J Bundy J, N Hage A, K Jairath N, J Gemmete J, N Srinivasa R, Chick JFB. Gianturco Z-stent placement for the treatment of chronic central venous occlusive disease: implantation of 208 stents in 137 symptomatic patients. ACTA ACUST UNITED AC 2021; 27:72-78. [PMID: 33090095 DOI: 10.5152/dir.2020.19282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the technical successes, adverse events, and long-term stent patency rates of Gianturco Z-stents for management of chronic central venous occlusive disease. METHODS Overall, 137 patients, with mean age 48.6±16.1 years (range, 16-89 years), underwent placement of Gianturco Z-stents for chronic central venous occlusions. Presenting symptoms included lower extremity edema (n=66, 48.2%), superior vena cava syndrome (n=30, 21.9%), unilateral upper extremity swelling (n=20, 14.6%), hemodialysis fistula or catheter dysfunction (n=11, 8.0%), ascites (n=8, 5.8%), and both ascites and lower extremity edema (n=2, 1.5%). Most common etiologies of central venous occlusion were prior central venous access placement (n=58, 42.3%), extrinsic compression (n=29, 21.2%), and post-surgical anastomotic stenosis (n=27, 19.7%). Number of stents placed, stent implantation location, stent sizes, technical successes, adverse events, need for re-intervention, follow-up evaluation, stent patencies, and mortality were recorded. Technical success was defined as recanalization and stent reconstruction with restoration of in-line venous flow. Adverse events were defined by the Society of Interventional Radiology Adverse Event Classification criteria. Primary and primary-assisted stent patencies were analyzed using Kaplan-Meier analysis. RESULTS In total, 208 Z-stents were placed. The three most common placement sites were the inferior vena cava (n=124, 59.6%), superior vena cava (n=44, 21.2%), and brachiocephalic veins (n=27, 13.0%). Technical success was achieved in 133 patients (97.1%). There were two (1.5%) severe adverse events (two cases of stent migration to the right atrium), one (0.7%) moderate adverse event, and one (0.7%) mild adverse event. Mean follow-up was 43.6±52.7 months. Estimated 1-, 3-, and 5-year primary stent patency was 84.2%, 84.2%, and 82.1%, respectively. Estimated 1-, 3-, and 5-year primary-assisted patency was 92.3%, 89.6%, and 89.6%, respectively. The 30- and 60- day mortality rates were 2.9% (n=4) and 5.1% (n=7), none of which were directly attributable to Z-stent placement. CONCLUSION Gianturco Z-stent placement is safe and effective for the treatment for chronic central venous occlusive disease with durable short- and long-term patencies.
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Affiliation(s)
- Joseph L McDevitt
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daryl T Goldman
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, New York, USA
| | - Jacob J Bundy
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Anthony N Hage
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA;Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Neil K Jairath
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ravi N Srinivasa
- Department of Interventional Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Vascular and Interventional Radiology, University of Washington Medical Center, Seattle, Washington, USA
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Cakir S, Guzelbey T, Mutlu IN, Kilickesmez O. Comparison of functional patency rates between paclitaxel-eluting versus plain balloon angioplasty in hemodialysis patients with central venous stenosis: An intra-individual comparison study. Ther Apher Dial 2021; 26:185-190. [PMID: 33891365 DOI: 10.1111/1744-9987.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/07/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
Central venous stenosis (CVS) is usually a late-diagnosed clinical entity that is common in hemodialysis patients. It causes various problems ranging from hemodialysis difficulty to loss of the arterio-venous (A-V) fistula. In the present study, we aimed to determine the effect of drug eluting balloon while excluding the influence of other variable factors by evaluating the same individuals with plain and paclitaxel-eluting balloons. This research was a prospective study of 18 symptomatic hemodialysis patients (age 50.9 ± 14.0 years, range 32-72 years; 11 male, 7 female) with CVS who underwent treatment by plain balloon angioplasty (PBA) and paclitaxel-eluting balloon angioplasty (PEBA) in our hospital from January 2016 to June 2017. First, third and sixth month central vein patency rates were compared. The median patency rates of central veins were 109.0 (range: 10-324) days after PBA and 238.5 (range: 157-501) days after PEBA (p < 0.001). There was no statistically significant difference between PBA and PEBA angioplasty in one-month patency (p ˃ 0.05). By contrast, a statistically significant difference was found between 3- and 6-month patency rates (p = 0.031 and p ˂ 0.001, respectively). Kaplan-Meier analysis revealed that the primary cumulative patency rate of PEBA was significantly longer than that of PBA (p ˂ 0.001). In this prospective study, PEBA patency is superior to PBA patency in the treatment of CVS in dialysis patients.
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Affiliation(s)
- Semih Cakir
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Tevfik Guzelbey
- Department of Radiology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ilhan N Mutlu
- Department of Radiology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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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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9
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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] [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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Park HS, Choi J, Baik JH. Central venous disease in hemodialysis patients. Kidney Res Clin Pract 2019; 38:309-317. [PMID: 31387161 PMCID: PMC6727898 DOI: 10.23876/j.krcp.19.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/18/2023] Open
Abstract
Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.
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Affiliation(s)
- Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonsung Choi
- Department of Radiology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jun Hyun Baik
- Department of Radiology, St. Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea
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Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JH, van Loon M, ESVS Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, ESVS Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:757-818. [DOI: 10.1016/j.ejvs.2018.02.001] [Citation(s) in RCA: 346] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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Hongsakul K, Bannangkoon K, Rookkapan S, Boonsrirat U, Kritpracha B. Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience. Korean J Radiol 2018; 19:410-416. [PMID: 29713218 PMCID: PMC5904467 DOI: 10.3348/kjr.2018.19.3.410] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/01/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To report the results of angioplasty with paclitaxel-coated balloons for the treatment of early restenosis of central veins in hemodialysis patients. Materials and Methods Sixteen patients (9 men and 7 women; mean age 65.8 ± 14.4 years; range, 40-82 years) with 16 episodes of early restenoses of central veins within 3 months (median patency duration 2.5 months) were enrolled from January 2014 to June 2015. Ten native central veins and 6 intra-stent central veins were treated with double paclitaxel-coated balloons (diameter 6-7 mm) plus a high pressure balloon (diameter 12-14 mm). The study outcomes included procedural success (< 30% residual stenosis) and primary patency of the treated lesion (< 50% angiographic stenosis without re-intervention). Results Procedural success was achieved in all 16 cases of central vein stenoses. The mean diameter of the central vein was 3.7 ± 2.4 mm before the procedure vs. 11.4 ± 1.8 mm after the initial procedure. There were no procedure-related complications. The mean diameters of the central veins at 6 months and 12 months were 7.8 ± 1.3 mm and 6.9 ± 2.7 mm, respectively. The primary patency rates at 6 months and 12 months were 93.8% and 31.2%, respectively. One patient had significant restenosis of the central vein at 3 months. The median primary patency period was 9 months for paclitaxel-coated balloons and 2.5 months for the last previous procedure with conventional balloons (p < 0.001). Conclusion In our limited study, paclitaxel-coated balloons seem to improve the patency rate in cases of early restenosis of central veins. However, a further randomized control trial is necessary.
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Affiliation(s)
- Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Kittipitch Bannangkoon
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Sorracha Rookkapan
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Ussanee Boonsrirat
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Boonprasit Kritpracha
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
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Maier RK, Menon D, Stafinski T. The Medical Devices Special Access Program in Canada: A Scoping Study. ACTA ACUST UNITED AC 2018; 13:40-57. [PMID: 29595436 PMCID: PMC5863869 DOI: 10.12927/hcpol.2018.25398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New health technologies enter Canadian healthcare organizations in various ways, and understanding them is essential to the development of a pan-Canadian Health Technology Management (HTM) Strategy, now a priority of governments across Canada. One way is through Health Canada's Medical Devices Special Access Program (MDSAP), which permits unlicensed devices to be obtained by healthcare professionals. However, the circumstances around and implications of the current use of this program are not clear. A scoping literature review was conducted to clarify these and identify important roles and issues related to the MDSAP. Limited information was found on the MDSAP. Nevertheless, three themes demonstrating the roles of the MDSAP in HTM emerged: arbiter in technology selection, a route to technology procurement and facilitator of health technology innovation. No information suggesting that MDSAP is used to circumvent licensing was found. Rather, it enables desired patient outcomes and product commercialization.
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Affiliation(s)
- Roland K Maier
- Graduate Student, School of Public Health, University of Alberta, Edmonton, AB
| | - Devidas Menon
- Professor, Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, AB
| | - Tania Stafinski
- Director, Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, AB
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14
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Endovascular treatment to boost AV fistula maturation. J Vasc Access 2017; 18:15-18. [DOI: 10.5301/jva.5000678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 11/20/2022] Open
Abstract
Impaired fistula maturation is associated with puncture-related complications, insufficient dialysis and potential permanent access failure. Non-maturation is frequently initiated by stenotic vascular access vessels comprising the outflow veins, the arteriovenous anastomosis and infrequently the inflow artery. Further findings in maturation protraction are central venous stenoses or accessory outflow veins. Depending on the underlying pathology, several endovascular approaches to boost fistula maturation are possible. To date standard balloon angioplasty remains the primary proven treatment option.
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15
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Huang Y, Chen B, Tan G, Cheng G, Zhang Y, Li J, Yang J. The feasibility and safety of a through-and-through wire technique for central venous occlusion in dialysis patients. BMC Cardiovasc Disord 2016; 16:250. [PMID: 27923353 PMCID: PMC5142130 DOI: 10.1186/s12872-016-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background To retrospectively compare the operation time, success rate and efficacy between unidirectional and bidirectional procedures in the treatment of central venous occlusion diseases (CVOD), assess the advantages of the bidirectional approach, and determine the characteristics of CVOD appropriate for the bidirectional approach treatment. Methods A total of 49 patients who underwent endovascular interventions with all relevant data between January 2011 and December 2015 at the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, were included in this retrospective study, and were categorized into two groups: the 19 patients in group 1 had undergone percutaneous transluminal venoplasty (PTV) via a conventional technique (unidirectional procedure from the vein distal or proximal to the obstructive lesion), and the 30 in group 2 had undergone flossing wire technique (bidirectional procedure from femoral vein and the vein distal to obstructive lesion and using a flossing wire technique). The technical success rate, the fluoroscopy time in the procedure, perioperative complications, and patency were evaluated retrospectively. Results Compared with group 1, group 2 had a higher initial technical success rate (83.33% vs. 47.36%, p = 0.012) but a shorter fluoroscopy time (82.6 ± 26.1 vs. 116.1 ± 42.1, p = 0.048). Receiver operating characteristic (ROC) analysis indicated that a lesion with a length of 6.5 cm was the best predictor of technique success (p = 0.02) in group 1, but no cut-off value was identified for group 2. There were no significant differences in perioperative complications between these two groups. The complication rates were 31.58% (6/19) in group 1 and 6.67% (2/30) in group 2, (p = 0.043), respectively. No significant difference was observed between these two groups with respect to the stent patency rate. Conclusion Compared with the conventional technique, the flossing wire technique has a higher success rate, shorter fluoroscopy time, fewer complications and similar patency rate. It is a feasible treatment for CVOD, especially for long obstructive lesions.
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Affiliation(s)
- Yonghui Huang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
| | - Bing Chen
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Guosheng Tan
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Gang Cheng
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Yi Zhang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jiaping Li
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jianyong Yang
- The Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
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16
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Tinelli C, Montagna G, Maestri M. Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients. Vasc Endovascular Surg 2016; 50:221-30. [PMID: 27097842 DOI: 10.1177/1538574416639149] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis. MATERIALS AND METHODS A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access (33, 47%) and tunneled catheters (37, 53%) was made. Three cohorts were compared: angioplasty alone (22), bare metal stent (28), and stent graft (20). Patencies were described with Kaplan-Meier method, and Cox uni- and multivariate models were analyzed to find factors associated. RESULTS All patients had a favorable anatomical and clinical outcome. Restenosis occurred in 22 (31%) of 70 patients requiring 41 additional interventions; 34 of 70 patients died (median follow-up 19.4 months). Primary patency at 3, 6, 12, and 24 months was 100%, 100%, 100%, and 84% for stent graft versus 90%, 79%, 58%, and 43% for angioplasty (P = .014) versus 84%, 80%, 75%, and 46% for bare-metal stent (P = .062). The overall comparison was more favorable for stent graft (P = .020) when the sites of lesions were matched. Patencies for angioplasty and bare-metal stents were equivalent (P = .141). A lower risk of restenosis (hazard rate [HR] 0.20, confidence interval [CI] 0.06-0.7) and fewer reinterventions (P < .01) were associated with stent graft, whereas age (HR 1.04, CI 1.001-1.08) and cardiovascular disease (HR 2.26, CI 1.06-4.84) influenced the overall survival. No difference in assisted primary patency was found. CONCLUSION Stent graft seems to improve primary patency for central venous stenosis and requires fewer reinterventions in a dialysis population with a high prevalence of long-term catheters.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Riccardo Corti
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Leati
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ilaria Fiorina
- Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giovanni Montagna
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy
| | - Marcello Maestri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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17
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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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Affiliation(s)
- Robert G. Jones
- Department of Interventional Radiology, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, UK
| | - Nicholas G. Inston
- Department of Renal Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, UK
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19
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Massmann A, Fries P, Obst-Gleditsch K, Minko P, Shayesteh-Kheslat R, Buecker A. Paclitaxel-Coated Balloon Angioplasty for Symptomatic Central Vein Restenosis in Patients With Hemodialysis Fistulas. J Endovasc Ther 2015; 22:74-9. [DOI: 10.1177/1526602814566907] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: To report a retrospective observational analysis of standard balloon angioplasty (BA) vs. paclitaxel-coated balloon angioplasty (PCBA) for symptomatic central vein restenoses in patients with impaired native hemodialysis fistulas. Methods: A retrospective review was conducted of 27 consecutive patients (15 men; mean age 66±13.8 years, range 39–90) with 32 central vein stenoses (CVS; 6 axillary, 11 subclavian, 12 brachiocephalic, and/or 3 superior caval veins) treated successfully using BA. Freedom from reintervention after BA of de novo lesions was 7.4±7.9 months (range 1–24). Twenty-five (92.6%) patients developed symptomatic restenoses and were treated one or more times by BA (n=32) or PCBA (n=20) using custom-made paclitaxel-coated balloons (diameter 6–14 mm). Results: Technical (<30% residual stenosis) and clinical (functional fistula) success rates for the initial and secondary angioplasty procedures were 100%. No minor/major procedure-associated complications occurred. Mean follow-up was 18.4±17.5 months. Kaplan-Meier analysis for freedom from target lesion revascularization (TLR) found PCBA superior to BA (p=0.029). Median freedom from TLR after BA was 5 months; after PCBA, >50% of patients were event-free during the observation period (mean freedom from TLR 10 months). Restenosis intervals were prolonged by PCBA (median 9 months) vs. BA (median 4 months; p=0.023). Conclusion: Paclitaxel-coated balloon angioplasty of central vein restenosis in patients with hemodialysis shunts yields a statistically significant longer freedom from TLR compared to standard balloon angioplasty.
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Affiliation(s)
- Alexander Massmann
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Fries
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Kerstin Obst-Gleditsch
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Department of General, Abdominal, and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
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20
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Quaretti P, Galli F, Moramarco LP, Corti R, Leati G, Fiorina I, Maestri M. Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation. Korean J Radiol 2014; 15:364-9. [PMID: 24843241 PMCID: PMC4023055 DOI: 10.3348/kjr.2014.15.3.364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/23/2014] [Indexed: 11/17/2022] Open
Abstract
Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.
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Affiliation(s)
- Pietro Quaretti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Franco Galli
- Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia 27100, Italy
| | - Lorenzo Paolo Moramarco
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Giovanni Leati
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Ilaria Fiorina
- Unit of Interventional Radiology - Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Marcello Maestri
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
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21
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Verstandig AG, Berelowitz D, Zaghal I, Goldin I, Olsha O, Shamieh B, Shraibman V, Shemesh D. Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access. J Vasc Interv Radiol 2013; 24:1280-7; quiz 1288. [PMID: 23806382 DOI: 10.1016/j.jvir.2013.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess long-term outcomes of stent grafts in patients with symptomatic central venous stenoses and occlusions ipsilateral to hemodialysis grafts or fistulas. MATERIALS AND METHODS The study included 52 of 55 consecutive patients with symptomatic stenoses of the central veins draining upper limb dialysis access grafts or fistulas treated with stent grafts. Indications for stent grafts were poor angioplasty results, rapid recurrence, or total occlusion. Endpoints were lesion patency and access patency following intervention. Mean follow-up was 25 months with a median of 24 months and 1.25 additional procedures per patient year. Patency rates were calculated using Kaplan-Meier analysis. RESULTS All stent grafts were successfully deployed. The lesion patency rates at 6, 12, 24, and 36 months after intervention were 60%, 40%, 28%, and 28%. The access patency rates at 6, 12, 24, and 36 months after intervention were 96%, 94%, 85%, and 72%. There was one major complication and no minor complications. In 40 patients (77%), the internal jugular vein confluence was covered by the stent graft. In five patients, the dialysis circuits became occluded, with no clinical sequelae in four; one patient was lost to follow-up. The contralateral brachiocephalic vein was covered in three patients (6%), preventing contralateral access construction in one patient. CONCLUSIONS Central vein stent graft placement in patients with hemodialysis access is associated with prolonged access patency. Coverage of major vein confluences, which occurred in 83% of the patients in this series, can compromise future access and should be avoided whenever possible by careful technique.
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Affiliation(s)
- Anthony G Verstandig
- Department of Radiology, Shaare Zedek Medical Center, POB 3235, Jerusalem IL-91031, Israel.
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Abstract
Central vein stenosis (CVS) is commonly seen in patients receiving hemodialysis through an arteriovenous access, threatening the usability of arteriovenous access for dialysis. Subclavian and internal jugular catheters are prime reasons for the development of CVS, especially in the setting of long-term use of multiple catheters. CVS related to cardiac rhythm devices also is seen frequently. Idiopathic CVS can be encountered, although it is less common. Clinical features ultimately become sufficiently prominent to prompt angiographic evaluation. CVS should be evaluated carefully because management must be individualized. The primary method for treatment of CVS is endovascular intervention, including angioplasty and stent placement, whereas surgical options should be pursued in only refractory cases due to the invasiveness of the intervention. Early referral of patients for chronic kidney disease care; timely discussion of kidney replacement modality choices, including nonhemodialysis options such as peritoneal dialysis and kidney transplantation; placement of arteriovenous access prior to the onset of dialysis; and avoidance of catheters and other central vein instrumentation will prevent the development of CVS in most patients with kidney disease.
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Affiliation(s)
- Anil K Agarwal
- Interventional Nephrology, The Ohio State University, Columbus, OH 43210, USA.
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23
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Central venous disease in hemodialysis patients: an update. Cardiovasc Intervent Radiol 2012; 36:898-903. [PMID: 23073561 DOI: 10.1007/s00270-012-0498-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.
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