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Zhao Y, Yang L, Wang Y, Zhang H, Cui T, Fu P. The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients. Phlebology 2020; 36:217-225. [PMID: 32928071 DOI: 10.1177/0268355520955090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen's kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.
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Affiliation(s)
- Yuliang Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Letian Yang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Yating Wang
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Huawei Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Tianlei Cui
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
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Cui T, Zhao Q, Zhou L, Li X, Fu P. A Case Report of a Direct Catheterization of Tunneled Cuffed Catheter via Superior Vena Cava: A Choice after Vascular Access Exhaustion. Blood Purif 2015; 40:79-83. [PMID: 26138408 DOI: 10.1159/000430905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/23/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To establish a new way for long-term vascular access for dialysis patient with vascular access exhaustion. MATERIALS AND METHODS A patient with diabetes was found with edema of right arm and high venous pressure of AVF during hemodialysis. Intervention operations were performed to establish a tunneled cuffed catheterization. RESULTS Occlusion of innominate vein was confirmed by MDCTV. Puncture to superior vena cava was successful 0.5 cm below the lateral head of sternocleidomastoid muscle directly via the right neck area. CONCLUSION Direct puncture via superior vena cava might be the last choice for catheter insertion site. choice for catheter insertion site.
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Affiliation(s)
- Tianlei Cui
- Division of Nephrology, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China
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Zhao Y, Cui T, Yu Y, Liu F, Fu P, Zhou L, Li X. Successful tunneled catheter placement in a hemodialysis patient with idiopathic multiple central venous stenoses. Hemodial Int 2013; 18:200-4. [PMID: 23879465 DOI: 10.1111/hdi.12067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuliang Zhao
- West China Medical School; Sichuan University; Chengdu China
| | - Tianlei Cui
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Yang Yu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Fang Liu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Ping Fu
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Li Zhou
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Xiao Li
- Department of Gastroenterology; West China Hospital; Sichuan University; Chengdu China
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