1
|
Li X, Abboud R, Kirksey L, Levitin A, Lyden S, Guan J, Gadani S, Kovach C, Quatormoni J, Morar S, Partovi S. Role and Value of Intravascular Ultrasound in the End-Stage Renal Disease Population: A Narrative Review. Ann Vasc Surg 2024; 108:295-306. [PMID: 38960094 DOI: 10.1016/j.avsg.2024.04.028] [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: 03/07/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 07/05/2024]
Abstract
Vascular access for hemodialysis is the lifeline for patients with end-stage renal disease (ESRD); therefore, maintenance of the vascular access is of the utmost importance. The dialysis circuit can be complicated by stenosis or thrombosis. In particular, central venous stenosis is frequently encountered in the vascular access of patients with ESRD, and this complication may require endovascular management. Conventional catheter-based venography may be inadequate for identifying dynamic forms of extrinsic compression and intravascular webs associated with these lesions. For these types of access complications, balloon angioplasty remains the first-line intervention, with stenting reserved for selected scenarios. Accurate assessment of the venous configuration is therefore important to ensure an adequate treatment response. Intravascular ultrasound (IVUS) has been shown to be beneficial in lower extremity venous interventions. The use of IVUS in dialysis access interventions is currently limited but may be indicated in selected challenging clinical situations. In this article, we discuss the potential uses of IVUS in the ESRD population based on our institutional experience and on the current literature.
Collapse
Affiliation(s)
- Xin Li
- Department of Radiology, Hospital of The University of Pennsylvania, Philadelphia, PA
| | - Rayan Abboud
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - Levester Kirksey
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Abraham Levitin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - Sean Lyden
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Justin Guan
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH
| | - Cassandra Kovach
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Jon Quatormoni
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Satya Morar
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH.
| |
Collapse
|
2
|
Sternbach S, Taggert J, Raible W, Sternbach Y, Ozsvath K. Venous pseudoaneurysm in a dialysis patient. J Vasc Surg Cases Innov Tech 2024; 10:101548. [PMID: 39069992 PMCID: PMC11277363 DOI: 10.1016/j.jvscit.2024.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/16/2024] [Indexed: 07/30/2024] Open
Abstract
We present a case of embolization for post-angioplasty pseudoaneurysm of the internal mammary vein. A 62-year-old male presented to the emergency department with right upper extremity edema. One month prior, he underwent angioplasty of right cephalic, subclavian, and innominate veins for similar symptoms but felt they had worsened. Computed tomography with intravenous contrast revealed pseudoaneurysm of the right internal mammary vein, and the patient was taken emergently to the operating room where embolization was successfully performed. Central venous pseudoaneurysm is a rare complication of angioplasty and the unique considerations of the anatomic region necessitate discussion of the optimal treatment modality.
Collapse
Affiliation(s)
- Sarah Sternbach
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - John Taggert
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - William Raible
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - Yaron Sternbach
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - Kathleen Ozsvath
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| |
Collapse
|
3
|
Hongsakul K, Janjindamai P, Akkakisee S, Rookkapan S, Bannangkoon K, Nisityotakul P, Boonsrirat U, Duangpakdee P, Premprabha D. Sharp recanalization with transseptal needle for unsuccessful standard recanalization of chronic thoracic central vein occlusion in hemodialysis patients. J Vasc Access 2024:11297298241278007. [PMID: 39238179 DOI: 10.1177/11297298241278007] [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: 09/07/2024] Open
Abstract
BACKGROUND Many cases of chronic thoracic central vein occlusion (CVO) fail to recanalize using the standard conventional guidewire technique. This study aims to present the outcomes of sharp recanalization with a transseptal needle in chronic thoracic CVO. METHODS This retrospective study involved 22 hemodialysis patients who developed clinical signs and symptoms of CVO, had unsuccessful conventional endovascular treatment using guidewire, and underwent sharp recanalization with a transseptal needle from January 2018 to December 2021. Demographic information of patients, technical success rate, and complications were kept. Post-intervention primary patency rate was examined using survival regression. RESULTS Thirteen men and nine women were enrolled with a median age of 50 years (range: 30-83 years). The most common site of thoracic CVO was the right brachiocephalic vein (21 patients). The average length of occlusion was 2.5 cm (range: 1-4.4 cm). Technical success rate was 90.9% (20 patients). Major complications occurred in three instances, including severe hemothorax and pulmonary edema. The median post-intervention primary patency between balloon angioplasty alone and primary stenting was 2.1 and 8.0 months (p = 0.015). Post-intervention primary patency rates at 6 and 12 months in the group receiving balloon angioplasty alone versus primary stenting were 33.3% and 0% versus 70.6% and 29.4% (p = 0.013). CONCLUSION Sharp recanalization with a transseptal needle is successful in chronic thoracic CVO cases that fail with conventional recanalization. Primary stenting in this CVO lesion shows a greater primary patency compared to balloon angioplasty alone.
Collapse
Affiliation(s)
- Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Phurich Janjindamai
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Surasit Akkakisee
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sorracha Rookkapan
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kittipitch Bannangkoon
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Panat Nisityotakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Ussanee Boonsrirat
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pongsanae Duangpakdee
- Division of Cardiovascular thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Dhanakom Premprabha
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
4
|
Lai QQ, Zhang H, Zhou Y, Chen B, Hu B, He F, Xu Y, Zhao WB, Wan ZM. Long-Term Outcome of a "Mother-Child" Coaxial Dual-Catheter Technique for Percutaneous Transluminal Angioplasty of Central Vein Stenosis or Occlusion in Hemodialysis Patients. J Endovasc Ther 2024; 31:643-650. [PMID: 36382889 DOI: 10.1177/15266028221136434] [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: 02/17/2024]
Abstract
PURPOSE This study aims to evaluate the long-term outcome and prognostic factors of a "mother-child" coaxial dual-catheter technique for percutaneous transluminal angioplasty (PTA) in the treatment of central vein stenosis (CVS) or central vein occlusion (CVO). MATERIALS AND METHODS During September 2017 to August 2020, totally, 76 hemodialysis patients with symptomatic CVS or CVO were treated with PTA using the mother-child technique. The success rate, complications, and follow-up information were collected. Cox proportional hazard analysis was used to explore the predicting factors of primary patency. Primary patency rates of different subgroups were generated with the Kaplan-Meier analysis and compared using the log-rank (Mantel-Cox) test. RESULTS There were 31 CVS patients and 45 CVO patients who presented with 114 PTAs. The initial procedure success rate was 98.25%. By the end of the follow-up, 57 patients (75%) had maintained functioning fistula after initial or repeated PTAs. The primary patency rates were 88.75% at 3 months, 73.36% at 6 months, 55.83% at 12 months, and 50.75% at 18 months. The secondary patency rates were 97.14% at 6 months, 87.66% at 12 months, and 82.18% at 24 months. The predictors for primary patency were history diabetes mellitus (hazard ratio [HR] = 3.1, 95% confidence interval [CI]: 1.31-7.30, P = .010), abnormal white blood cell count (HR = 1.44, 95% CI: 1.18-1.75, P < .001), lesion at subclavian-innominate vein (HR=2.75, 95% CI: 1.34-5.63, P = .006), and occlusion (HR=0.33, 95% CI: 0.14-0.76, P = .010). The primary patency was significantly lower in the subclavian-innominate vein subgroup, with a median primary patency of 4.5 (3-12.75) months, than in the nonsubclavian-innominate vein subgroup (8.5 [5-13] months; P = .005). The median duration of each PTA was 8 months for the first PTA, 7.5 months for the second PTA, and 5 months for the third PTA. There was no significant difference in the patency duration of repeated PTAs and the primary PTA (P = .389). CONCLUSIONS The mother-child coaxial dual-catheter technique has a good success rate and acceptable primary patency in the treatment of hemodialysis patients with CVS or CVO. Repeated PTA is as effective as the primary PTA. CLINICAL IMPACT This is the follow up report on the "Mother-Child" coaxial dual-catheter technique for percutaneous transluminal angioplasty of central vein stenosis or occlusion in hemodialysis patients since we first presented it in 2019. In this paper, we can see that the long-term patency rate of this technique for central venous disease is satisfactory, and repeated use of this technique does not affect the patency time. Compared with other literature reports, the surgical success rate of this technique is significantly improved. Therefore, this technique is worth popularizing in the treatment of central venous disease.
Collapse
Affiliation(s)
- Qi-Quan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Zhang
- Department of Medical, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Chen
- Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Hu
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangdong, China
| | - Fan He
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Xu
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zi-Ming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Lok CE, Huber TS, Orchanian-Cheff A, Rajan DK. Arteriovenous Access for Hemodialysis: A Review. JAMA 2024; 331:1307-1317. [PMID: 38497953 DOI: 10.1001/jama.2024.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Hemodialysis requires reliable vascular access to the patient's blood circulation, such as an arteriovenous access in the form of an autogenous arteriovenous fistula or nonautogenous arteriovenous graft. This Review addresses key issues associated with the construction and maintenance of hemodialysis arteriovenous access. Observations All patients with kidney failure should have an individualized strategy (known as Patient Life-Plan, Access Needs, or PLAN) for kidney replacement therapy and dialysis access, including contingency plans for access failure. Patients should be referred for hemodialysis access when their estimated glomerular filtration rate progressively decreases to 15 to 20 mL/min, or when their peritoneal dialysis, kidney transplant, or current vascular access is failing. Patients with chronic kidney disease should limit or avoid vascular procedures that may complicate future arteriovenous access, such as antecubital venipuncture or peripheral insertion of central catheters. Autogenous arteriovenous fistulas require 3 to 6 months to mature, whereas standard arteriovenous grafts can be used 2 to 4 weeks after being established, and "early-cannulation" grafts can be used within 24 to 72 hours of creation. The prime pathologic lesion of flow-related complications of arteriovenous access is intimal hyperplasia within the arteriovenous access that can lead to stenosis, maturation failure (33%-62% at 6 months), or poor patency (60%-63% at 2 years) and suboptimal dialysis. Nonflow complications such as access-related hand ischemia ("steal syndrome"; 1%-8% of patients) and arteriovenous access infection require timely identification and treatment. An arteriovenous access at high risk of hemorrhaging is a surgical emergency. Conclusions and Relevance The selection, creation, and maintenance of arteriovenous access for hemodialysis vascular access is critical for patients with kidney failure. Generalist clinicians play an important role in protecting current and future arteriovenous access; identifying arteriovenous access complications such as infection, steal syndrome, and high-output cardiac failure; and making timely referrals to facilitate arteriovenous access creation and treatment of arteriovenous access complications.
Collapse
Affiliation(s)
- Charmaine E Lok
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas S Huber
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Dheeraj K Rajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Zhan S, Zhang L, Xiao G, Wang Y. Creation of an arteriovenous graft for hemodialysis using a previously placed stent graft: A case report. J Vasc Access 2024; 25:658-662. [PMID: 36172644 DOI: 10.1177/11297298221124874] [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: 11/15/2022] Open
Abstract
Successful hemodialysis (HD) treatment depends on well-functioning arteriovenous access. Thrombosis and stenosis are the main causes of access failure. The current report describes the successful establishment of an arteriovenous graft for HD using a previously placed stent graft in an HD patient who developed multiple episodes of access stenosis and thrombosis.
Collapse
Affiliation(s)
- Shen Zhan
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Lihong Zhang
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Guanghui Xiao
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Yuzhu Wang
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
D'Amico R, Nicoli A, Zdoroveac A, Gürke L, Isaak A. Vascular access challenges in hemodialysis patients with superior vena cava syndrome. J Vasc Access 2024:11297298241227549. [PMID: 38316621 DOI: 10.1177/11297298241227549] [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: 02/07/2024] Open
Abstract
BACKGROUND Superior vena cava syndrome in hemodialysis patients resulting from previous or current use of a tunneled central vein catheter is a rare but potentially severe condition. Two aspects have to be addressed during management and treatment: the restoration of central venous flow and the creation of an alternative vascular access to guarantee hemodialysis. RESEARCH DESIGN Conforming to the current guidelines and literature, we present a stepwise approach and discuss therapeutic options. The removal of the tunneled central vein catheter should be attempted and a native vascular access created whenever feasible. RESULTS First, an upper extremity AVF should be preserved or, as in our case, made functional. Endovascular treatment of CVSO should primarily consist of balloon dilatation. Placement of a stent or stent graft should be considered as a secondary option. HeRO graft placement may be considered in recurrent CVSO and recanalization with a Surfacer. LL-AVF or AVG need to be discussed and may be an alternative for certain HD patients when the risk of lower limb ischemia and infection is considered. CONCLUSION Several therapeutic options are available and the basic principles are well established in the literature, although the level of evidence is not high. Therefore, we propose a stepwise and interdisciplinary approach to guide the challenging decision-making process in SVC.
Collapse
Affiliation(s)
- Rosalinda D'Amico
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland
| | - Andrew Nicoli
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland
| | - Andrei Zdoroveac
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland
| | - Lorenz Gürke
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland
- Vascular and Endovascular Surgery, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Andrej Isaak
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland
- Vascular and Endovascular Surgery, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| |
Collapse
|
10
|
Ali AE, Al-Balas A, Benson PV, Almehmi A. Fatal superior vena cava rupture complicating dialysis catheter exchange. J Vasc Access 2024:11297298231219288. [PMID: 38166439 DOI: 10.1177/11297298231219288] [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: 01/04/2024] Open
Abstract
Central vein stenosis (CVS) is a common and challenging complication in hemodialysis patients with chronic central venous catheters (CVCs). CVS often remains asymptomatic and is discovered incidentally during follow-up imaging. CVS symptoms include arm swelling, venous hypertension, impaired dialysis flow rates, and development of collateral veins. However, these symptoms can be nonspecific and overlap with other conditions, making the diagnosis challenging. Timely recognition and appropriate intervention are crucial to prevent complications and optimize patient outcomes. Diagnostic tools commonly used include duplex ultrasonography and venography to assess the degree and location of stenosis. Management strategies for CVS encompass a multidisciplinary approach involving nephrologists, interventional radiologists, and vascular surgeons. Initial conservative measures may include anticoagulation therapy, along with pharmacological interventions such as antiplatelet agents and thrombolytics. The endovascular approach is the first line for managing CVS by using balloon angioplasty either alone or in combination with stent placement, but CVS typically recurs frequently, requiring repeated interventions with an increased risk of complications. Additionally, alternative vascular access options such as arteriovenous fistulas or grafts may be considered. In this report, we describe a case of a 25-year-old woman who presented with an extensive history of multiple dialysis access failure for left internal jugular vein central venous tunneled catheter exchange. The procedure was complicated by a fatal superior vena cava rupture likely related to the dislodgment of the guidewire causing perforation into the pericardium space with subsequent cardiopulmonary collapse. The post-mortem autopsy showed severe organized stenosis of SVC and transmural defect above the SVC/atrial junction.
Collapse
Affiliation(s)
- Ahmed E Ali
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alian Al-Balas
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul V Benson
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammar Almehmi
- Department of Radiology and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Kitrou P, Katsanos K, Karnabatidis D. Management of Central Venous Stenoses and Occlusions. Cardiovasc Intervent Radiol 2023; 46:1182-1191. [PMID: 37460644 PMCID: PMC10471665 DOI: 10.1007/s00270-023-03461-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/01/2023] [Indexed: 09/02/2023]
Abstract
Symptomatic central venous stenosis and occlusion remains the gordian knot of vascular access. Advances in techniques, like sharp recanalization, allowed for improved success rates in crossing these difficult lesions. There is also increasing evidence of new devices in treating central venous stenosis and, at the same time, improving the time needed between interventions. High-pressure balloons, paclitaxel-coated balloons, bare metal stents and covered stents have been tested with an aim to offer additional treatment options, although obstacles still exist. In the current review, authors describe relevant techniques and options, provide the evidence and evaluate the actual implementation of these devices in this demanding field.
Collapse
Affiliation(s)
- Panagiotis Kitrou
- Interventional Radiology, Patras University Hospital, Patras, Greece.
- Medical School, University of Patras, Patras, Greece.
| | - Konstantinos Katsanos
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
| | - Dimitrios Karnabatidis
- Interventional Radiology, Patras University Hospital, Patras, Greece
- Medical School, University of Patras, Patras, Greece
| |
Collapse
|
13
|
Aronhime S, Balan S, Timokhin A, Avital Y, Cherniavsky A. Early experience with the Abre venous stent for central venous stenoses and occlusions in hemodialysis patients. J Vasc Access 2023:11297298231193893. [PMID: 37622463 DOI: 10.1177/11297298231193893] [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: 08/26/2023] Open
Abstract
BACKGROUND Hemodialysis patients are prone to stenoses and occlusions throughout the access circuit. Central venous stenoses or occlusions (CVO) can be particularly challenging. There are many different types of balloons and stents available for treatment, including a new generation of dedicated venous stents (VS). In this study, we report our experience and patency rates with the Abre VS in central venous lesions in hemodialysis patients. METHODS From April 2020 to May 2023, all procedures with Abre VSs placed for central venous lesions in hemodialysis patients were retrospectively analyzed from a prospectively collected database of 980 hemodialysis access interventions. Follow up outcomes were obtained from angiographic images on follow up angiography and included primary patency and primary assisted patency. Effective hemodialysis was considered a surrogate for access patency if no angiographic follow-up was available. RESULTS A total of 15 patients with CVO were treated with the Abre VS. Technical success was 100%. All patients were able to achieve adequate hemodialysis after VS placement. Stents were placed across the thoracic inlet in 73% of patients. Post procedure primary patency at the target lesion site was 85% at 6 months and 70% at 12 months. Primary assisted patency of the circuit was 93% at 6 and 12 months. No stent fractures were observed. CONCLUSION Treatment of CVO remains extremely challenging, especially when the lesion is located at the thoracic inlet. In these patients, VSs provide acceptable primary patency rates and allow patients to continue to receive effective hemodialysis. However, routine follow-up and re-interventions will likely be necessary to maintain patency in the long term.
Collapse
Affiliation(s)
- Shimon Aronhime
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Tel Aviv University, Beer Yaakov, Israel
| | - Shmuel Balan
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Tel Aviv University, Beer Yaakov, Israel
| | - Aleksey Timokhin
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Tel Aviv University, Beer Yaakov, Israel
| | - Yaniv Avital
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Tel Aviv University, Beer Yaakov, Israel
| | - Alexei Cherniavsky
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Tel Aviv University, Beer Yaakov, Israel
| |
Collapse
|
14
|
Bissacco D, Mandigers TJ, Romagnoli S, Aprea T, Lomazzi C, D'Alessio I, Ascenti V, Ierardi AM, Domanin M, Tolva VS, Carrafiello G, Trimarchi S. Acute venous problems: Integrating medical, surgical, and interventional treatments. Semin Vasc Surg 2023; 36:307-318. [PMID: 37330243 DOI: 10.1053/j.semvascsurg.2023.04.013] [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] [Received: 02/11/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
Collapse
Affiliation(s)
- Daniele Bissacco
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy.
| | - Tim J Mandigers
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Aprea
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Vascular Surgery Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianpaolo Carrafiello
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
15
|
Wen C, Chen B, Lin R, Dai H, Tang K, Zhang G, Huang J, Liao C, Zeng L, Xiang X, Yang J, Huang Y. Clinical Implications of Phenotypes of Hemodialysis Patients With Central Venous Occlusion or Central Venous Stenosis Defined by Cluster Analysis. Front Cardiovasc Med 2022; 9:901237. [PMID: 35795365 PMCID: PMC9251183 DOI: 10.3389/fcvm.2022.901237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to investigate the association between clinical factors of patients with central (superior vena cava, brachiocephalic, or subclavian) venous occlusion or central venous stenosis (CVO/CVS) and the difficulty of interventional recanalization as well as the duration of postoperative patency. Methods A total of 103 hemodialysis patients with CVO/CVS treated with endovascular treatment were enrolled. The two-step cluster analysis was selected to differentiate the cases into distinct phenotypes automatically. Differences in characteristics, the difficulty of interventional recanalization, and the duration of postoperative primary patency time between the two clusters were statistically compared. Results The 103 cases were divided into distinct two clusters by the two-step cluster analysis with 48 (46.6%) in cluster 1 and 55 (53.4%) in cluster 2. Compared to cluster 2, patients in cluster 1 have a higher proportion of blunt stump, side branches, occlusion lesions >2 cm, calcification, or organization. Moreover, the above four factors were, in turn, the most critical four predictors distinguishing 103 patients into two clusters. The remaining six factors were, in turn, occlusion located in the superior vena cava (SVC), duration of central venous catheterization (CVC), lesion location, vessel diameter, number of CVC, and previously failed lesion. Of the four most important factors, with the exception of occlusion lesions exceeding 2 cm, there were significant differences in the length of procedure time between the groups grouped by the remaining three factors. And there was a significant difference in the primary patency rate between the group with blunt stump and the group without blunt stump and also between the group with occlusion lesions ≥ 2 cm and the group with occlusion lesions <2 cm. The operation time of cluster 1 was longer than that of cluster 2. In terms of postoperative patency time, the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1 (P = 0.025). Conclusion Patients were divided into distinct two clusters. CVO/CVS of patients in cluster 1 was more challenging to be recanalized than that in cluster 2, and the primary patency time was significantly longer in the patients of cluster 2 compared with cluster 1. Blunt stump, side branches, occlusion lesions exceeding 2 cm, and calcification or organization are the four most critical predictors distinguishing 103 patients into two clusters.
Collapse
|
16
|
Hu X, Li B, Mao J, Hu X, Zhang J, Guo H, Wang D, Zhang Y, He J, Zhao N, Zhang H, Pang P. Hemodialysis Arteriovenous Fistula Dysfunction: Retrospective Comparison of Post-thrombotic Percutaneous Endovascular Interventions with Pre-emptive Angioplasty. Ann Vasc Surg 2022; 84:286-297. [PMID: 35247533 DOI: 10.1016/j.avsg.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/11/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to compare the clinical outcomes of pre-emptive angioplasty versus post-thrombotic percutaneous endovascular restoration of dysfunctional arteriovenous fistula (AVF). METHODS This retrospective study reviewed data from 80 patients who underwent 114 endovascular interventions for a malfunctioning AVF from July 2016 to August 2019. Stenotic AVFs were treated with pre-emptive angioplasty. Thrombosed AVFs were treated with percutaneous pharmacomechanical fibrinolysis with urokinase used only during the operation or continuously infused. The differences in patency rates were evaluated using Kaplan-Meier method. In addition, univariate and multivariate regression Cox models were used to determine influential factors on the post-intervention primary patency. RESULTS Post-thrombotic interventions and pre-emptive angioplasty yielded statistically similar rates in clinical success (100% vs 100%), anatomic success (94% vs 89%; p = .52), complication (4% vs 11%; p = .29), as well as postintervention primary, assisted primary and secondary patency (p = .80; .57; .57). The use of pre-emptive angioplasty was associated with reduced total cost (¥25108 vs ¥30833, p< .001). The patients who used urokinase only during the operation prolonged both the primary and assisted primary patency (p = .02; .002), while those with continuous infusion of urokinase had worst patency rates and high costs (¥39275 vs ¥25108 vs ¥27140, p< .001). Compared with the other locations, dysfunction in the anastomotic or juxta-anastomotic segment (HR = .41, p = .001) was associated with prolonged postintervention primary patency. CONCLUSIONS No clinical outcome differences was found between the post-thrombotic percutaneous endovascular interventions and pre-emptive angioplasty. However, pre-emptive angioplasty decreased access expenditure.
Collapse
Affiliation(s)
- Xinyan Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Bing Li
- Department of Ophthalmology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Junjie Mao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Xiaojun Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jingjing Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Hui Guo
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Dashuai Wang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Yongyu Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jianan He
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Ni Zhao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Huitao Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Pengfei Pang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China.
| |
Collapse
|
17
|
Ma W, Zhao Z, Fu Q, Hu L, Zhao X, Wang C, Liu Y. Comparison of Management for Central Venous Stenosis With or Without Previous Catheter Placement. Front Neurol 2021; 12:703286. [PMID: 34621234 PMCID: PMC8490807 DOI: 10.3389/fneur.2021.703286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To compare central venous stenosis/occlusion with or without previous jugular catheter placement history. Methods: Data of patients with central vein stenosis/occlusion receiving endovascular intervention in our hospital from January 2015 to December 2018 were collected and analyzed. Results: Twenty-nine patients with previous jugular catheter placement history (CVC group) and 33 patients (excluded two with technical failure) without such history (non-CVC group) are included in this study. Previous jugular catheter placement history raised the risk of postintervention recurrence 1.02 times (CVC group vs. non-CVC group, HR = 2.02 95%CI: 0.91–4.48). The primary patency rate at 6, 12, 18, and 24 months was 76.9, 54.2, 45.5, and 25.0% separately in the CVC group and 80.6, 70.0, 67.9, and 44.4% separately in the non-CVC group. The assisted primary patency rate at 6, 12, 18, and 24 months was 92.3, 91.7, 86.4, and 68.8% separately in the CVC group and 93.5, 90.0, 82.1, and 61.1% separately in the non-CVC group. Patients in the CVC group received a higher frequency of reintervention (0.7 times/year/patient vs. 0.3 times/year/patient). There was no significant difference in the assisted primary patency rate between the two groups. Different primary interventions (angioplasty alone, bare metal stent, stent graft) did not affect primary patency and assisted primary patency, but percutaneous transluminal stenting (PTS) with a bare metal stent had a significant lower primary patency rate between 3 and 24 months compared with PTS with a stent graft (p = 0.011). Conclusion: Central venous stenosis/occlusion with a previous jugular catheter placement history develops symptoms earlier and had a worse prognosis after endovascular intervention. More efforts are needed to carry out end-stage kidney disease life plan to reduce the harm of evitable catheter placement.
Collapse
Affiliation(s)
- Wei Ma
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengde Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qining Fu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liangzhu Hu
- Department of Vascular Surgery, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Xia Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Wang
- Department of Vascular Surgery, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yangdong Liu
- Department of Vascular Surgery, South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| |
Collapse
|
18
|
Cui L, Gao D, Lu X, Gao Z, Yuan H, Hu F. A retrospective cohort study comparing high and low balloon inflation pressure on technical success and patency for treating central venous lesions in patients on chronic hemodialysis. Ren Fail 2021; 43:1281-1287. [PMID: 34503376 PMCID: PMC8439207 DOI: 10.1080/0886022x.2021.1975741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to analyze the success rates and the access patency rates at 12 months between patients on chronic hemodialysis with symptomatic central venous stenosis (CVS) or occlusion (CVO), receiving high or low balloon inflation pressure for treatment. Methods We performed a retrospective study in which angioplasty balloons were inflated using a low-pressure or a high-pressure for the management of hemodialysis patients with CVS/CVO. The outcomes of this study were the success rate and the access patency rates at 12 months after balloon angioplasty, and the differences between groups were compared. Results We included a total of 74 patients on hemodialysis and assigned them to the low-pressure or the high-pressure groups. Success rates in patients of the high-pressure group (94.12%) were higher than those in patients of the low-pressure group (67.50%) (p = 0.005). With a total of 59 patients with technical success, at 6 and 12 months after angioplasty, the rates of access patency in the low-pressure group were 68 and 48%, respectively; on the other hand, the primary patency rates in the high-pressure group were 86.67% (6-months) and 76.67% (12-months). The 6 and 12 months post-interventional patency rates were higher in patients of the high-pressure group than those in patients of the low-pressure group (p = 0.10 at 6 months and p = 0.03 at 12 months). Conclusions Compared to balloon angioplasty using a low inflation pressure, hemodialysis patients with CVS/CVO receiving angioplasty using a high inflation pressure have significantly higher technical success and 12-month patency rates.
Collapse
Affiliation(s)
- Long Cui
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Dan Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaohan Lu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Hai Yuan
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Fengqi Hu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| |
Collapse
|
19
|
Paulussen E, Decloedt A, Vera L, Lefere L, van Loon G. Unilateral jugular vein stenosis in five horses and experience with percutaneous transluminal angioplasty. Equine Vet J 2021; 54:710-718. [PMID: 34486172 DOI: 10.1111/evj.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/07/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Venous stenosis, a possible cause of jugular dilatation and congestion, is well known in human medicine but has poorly been described in horses. OBJECTIVE To report unilateral jugular vein stenosis as a cause of jugular vein dilatation in horses and describe treatment by percutaneous transluminal angioplasty (PTA). STUDY DESIGN Case report. METHODS Details of horses diagnosed with unilateral jugular stenosis were retrieved from medical records. RESULTS Five horses were presented with a non-painful, unilateral dilatation of the jugular vein of which two horses showed headshaking during exercise. In one horse an indwelling catheter had been used and jugular dilatation developed 4 weeks later. In the other horses, no intravenous injections had been administered in the months before jugular dilatation developed. Ultrasonographic examination revealed venous stenosis in all horses approximately 5-10 cm cranial to the thoracic inlet. The internal diameter at the level of this stenosis was only 1-3.1 mm. The length of the stenosis was about 15-19 mm with a markedly thickened intima and media on ultrasonography. After enoxaparin treatment, PTA was performed in three horses. During the procedure the stenotic vein was dilated three times with progressively increasing pressures up to 12 atm. The stenotic diameter increased to a maximum of 4.9 mm with improved jugular blood flow. Aftercare included anti-inflammatory and anti-thrombotic therapy. CONCLUSION Jugular vein stenosis occurs in horses and should be included in the differential diagnoses of unilateral jugular vein dilatation. It may present in the absence of previous intravenous treatment. PTA of the jugular vein is feasible to improve jugular blood flow.
Collapse
Affiliation(s)
- Ellen Paulussen
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lisse Vera
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Laurence Lefere
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
20
|
Percutaneous transluminal stenting for superior vena cava syndrome caused by malignant tumors: a single-center retrospective study. J Cardiothorac Surg 2021; 16:39. [PMID: 33743767 PMCID: PMC7981896 DOI: 10.1186/s13019-021-01418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the efficacy of percutaneous stent placement in the treatment of superior vena cava syndrome caused by malignant tumors. Methods We retrospectively analyzed the clinical data of 32 patients with superior vena cava syndrome who underwent percutaneous endovascular stent treatment in our department from 2015 to 2019 due to malignant tumors and summarized the patient’s sex, age, tumor type, endovascular treatment plan, complications and postoperative follow-up. Results All patients successfully underwent percutaneous intraluminal stent placement with digital subtraction angiography (DSA). Thirty-seven endovascular stents were implanted in 32 patients, including 21 Eluminexx stents, 12 Wallstent stents and 4 covered stents. The technical success rate was 100%, and there were no serious surgery-related complications. The remission rate of clinical symptoms was 53.1% (17/32) at 24 h and 84.4% (27/32) at 48 h. After 48 h, the symptoms of the remaining patients were slowly relieved, and the symptom relief rate was 100% at 7 days. The follow-up period was 1.5–24 months, with an average follow-up period of 6.5 months. During the follow-up, 3 patients had restenosis and 1 patient had secondary thrombosis in the stent. Their symptoms were relieved after the second treatment. Conclusion For superior vena cava syndrome caused by malignant tumors, percutaneous endoluminal stent therapy can quickly and effectively relieve the clinical symptoms of patients, and the incidence of complications is low.
Collapse
|
21
|
Jeon YH, Yi KS, Choi CH, Kim Y, Park YT. Dilatation of Superior Ophthalmic Vein and Visual Disturbance by Central Venous Stenosis: A Case Mimicking Cavernous Sinus Dural Arteriovenous Fistula. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1619-1627. [PMID: 36238885 PMCID: PMC9431976 DOI: 10.3348/jksr.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
투석 환자에서 중심정맥협착은 비교적 흔한 합병증이나, 이로 인한 경정맥역류 및 두개내압 상승은 드물며, 진행성 시력 저하를 보이는 경우는 몇 개의 증례만 보고되고 있다. 저자들은 경정맥역류로 인한 두개내압 상승, 시력 저하 그리고 뇌 MRI에서의 상안정맥 확장에 대해 해면경막 동정맥루로 오인하였던 증례를 보고하고자 한다. 환자는 time-of-flight MR angiography (이하 TOF-MRA)에서 경정맥역류 소견이 있었고, 혈관조영술에서 좌측 완두정맥의 협착이 확인되었다. 중심정맥협착에 대해 풍선혈관성형술을 시행하였고 증상이 호전되어 퇴원하였다. 중심정맥협착에 의한 경정맥역류와 해면경막 동정맥루는 유사한 증상을 보일 수 있으나 치료법이 다르므로, MRI와 TOF-MRA의 면밀한 검토를 토대로 영상의학적으로 감별하는 것이 중요하며, 뇌혈관조영술을 통해 중심정맥협착 유무를 확인하는 것이 필요하다.
Collapse
Affiliation(s)
- Young Hun Jeon
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Chi Hoon Choi
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
- Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yeong Tae Park
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| |
Collapse
|
22
|
Patel MD, Sivarajah R. Unknown Case: Unilateral Breast Edema. JOURNAL OF BREAST IMAGING 2020; 2:629-632. [PMID: 38424846 DOI: 10.1093/jbi/wbaa027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Indexed: 03/02/2024]
Affiliation(s)
- Megha D Patel
- Penn State Health Milton S. Hershey Medical Center, Department of Radiology, Hershey, PA
| | - Rebecca Sivarajah
- Penn State Health Milton S. Hershey Medical Center, Department of Radiology, Hershey, PA
| |
Collapse
|
23
|
Aljarrah Q, Allouh M, Hallak AH, Alghezawi SE, Al-Omari M, Elheis M, Al-Jarrah M, Bakkar S, Aleshawi AJ, Al-Jarrah H, Ibrahim KS, Al Shishani JM, Almukhtar A. Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease. Vasc Health Risk Manag 2020; 16:419-427. [PMID: 33116552 PMCID: PMC7553251 DOI: 10.2147/vhrm.s273450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis. Patients and Methods The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson’s chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs. Results The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01). Conclusion Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.
Collapse
Affiliation(s)
- Qusai Aljarrah
- Department of General & Vascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammed Allouh
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates
| | - Amer H Hallak
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Shamikh E Alghezawi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mamoon Al-Omari
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mwaffaq Elheis
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mooath Al-Jarrah
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Abdelwahab J Aleshawi
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hussam Al-Jarrah
- Department of General & Vascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Khalid S Ibrahim
- Department of General & Cardiovascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | | | - Aws Almukhtar
- Department of Surgery and Cancer, Imperial College London, London SW7 2BU, UK
| |
Collapse
|
24
|
Tasaki Y, Sueyoshi E, Takamatsu H, Matsushima Y, Miyamura S, Sakamoto I, Mochizuki Y, Uetani M. The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients. Medicine (Baltimore) 2020; 99:e21890. [PMID: 32899019 PMCID: PMC7478692 DOI: 10.1097/md.0000000000021890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ± 14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ± 21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.
Collapse
Affiliation(s)
- Yutaro Tasaki
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroko Takamatsu
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Yoshifumi Matsushima
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Shuto Miyamura
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Ichiro Sakamoto
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Yasushi Mochizuki
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| |
Collapse
|