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Fereydooni A, Sgroi MD. Management of thoracic outlet syndrome in patients with hemodialysis access. Semin Vasc Surg 2024; 37:50-56. [PMID: 38704184 DOI: 10.1053/j.semvascsurg.2024.01.004] [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: 10/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. The authors reviewed the management of dialysis patients with central venous lesions at the thoracic outlet, as well as the role of surgical decompression with first-rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304
| | - Michael David Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304.
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2
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Chen J. A case of thoracic central venous obstruction treated by the innominate-to-right-atrial bypass grafting technique under extracorporeal circulation. J Surg Case Rep 2024; 2024:rjae050. [PMID: 38404443 PMCID: PMC10894679 DOI: 10.1093/jscr/rjae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/21/2024] [Indexed: 02/27/2024] Open
Abstract
A 46-year-old woman with stage 5 chronic kidney disease was unable to undergo hemodialysis treatment due to thoracic central venous obstruction (TCVO) and blockage of the tunneled cuffed catheter. This patient also presented with symptoms of TCVO. When percutaneous procedure was not possible, we resolved the obstruction with the innominate-to-right-atrial bypass grafting technique under extracorporeal circulation. There are few reports on this surgical approach. In terms of patient prognosis, this may be an effective solution to this problem.
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Affiliation(s)
- Jianfeng Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China
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Paik B, Tee ZH, Masuda Y, Choong AM, Ng JJ. A systematic review of right atrial bypass grafting in the management of central venous occlusive disease in patients undergoing hemodialysis. J Vasc Access 2024; 25:14-26. [PMID: 35531762 DOI: 10.1177/11297298221095320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Central venous occlusive disease (CVOD) is a complication that can occur in patients with end-stage renal disease who are receiving hemodialysis. When CVOD develops, patients often require multiple re-interventions to maintain their dialysis access. CVOD can be treated by various strategies such as balloon angioplasty, stenting, lower limb or extra-anatomical grafts, hybrid grafts or surgical bypasses such as right atrial (RA). In this systematic review, we aim to evaluate the indications, technical aspects, and outcomes after RA bypass grafting for the treatment of CVOD in hemodialysis patients. METHODS A systematic and comprehensive literature search was conducted using various electronic databases. We included articles that reported described and reported outcomes of RA bypass grafting for the treatment of CVOD in hemodialysis patients. A narrative review of the indications and technical aspects of RA bypass grafting was performed. We also pooled and reported the primary patency, secondary patency, postoperative complications, and 30-day mortality of RA bypass grafting. RESULTS A total of 21 studies with 55 patients who underwent RA bypass grafting were included in our systematic review. Follow-up period ranged from 0.5 to 84 months. The mean pooled primary patency and secondary patency of RA bypass grafting were 8.1 ± 4.9 and 21.7 ± 20.1 months, respectively. The incidence of early postoperative complications such as surgical site infection, bleeding, and access thrombosis was 0%, 4%, and 4%, respectively. The overall 30-day mortality was 4%. CONCLUSIONS This systematic review summarizes the patient characteristics, technical features and outcomes of RA bypass grafting in the treatment of hemodialysis-related CVOD. RA bypass grafting may be a viable last-resort option when less invasive or conventional treatment options have been exhausted.
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Affiliation(s)
- Benjamin Paik
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zi Heng Tee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Yoshio Masuda
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Mtl Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
- Cardiovascular Research Institute, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
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Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, Schellack J, Kumbala D. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. FRONTIERS IN NEPHROLOGY 2023; 3:1280666. [PMID: 38022724 PMCID: PMC10664753 DOI: 10.3389/fneph.2023.1280666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Abdulkareem Lukan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States
| | - Gaurav Sharma
- Department of Nephrology, AIIMS Rishikesh, Rishikesh, India
| | - Indranill Basu-Ray
- Department of Cardiology, AIIMS Rishikesh, Rishikesh, India
- Department of Cardiovascular Disease, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
| | - London Guidry
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Jon Schellack
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
| | - Damodar Kumbala
- Vascular Clinic of Baton Rouge, Baton Rouge, LA, United States
- Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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Carleton J, Chang J, Richard Pu Q, Rhee R. Internal jugular to internal jugular vein bypass of symptomatic central vein obstruction. J Vasc Access 2022; 24:11297298211070703. [PMID: 35001732 DOI: 10.1177/11297298211070703] [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: 11/16/2022] Open
Abstract
INTRODUCTION Central venous obstruction (CVO) often arises among hemodialysis patients with upper extremity access due to a varying number of risk factors. While the true incidence of CVO in hemodialysis patients is unknown, it been reported in the range of 20%-40% in dialysis patients undergoing venograms. In the non-hemodialysis population, chronic central vein obstruction has a compensatory mechanism comprised of numerous collaterals along the chest wall, neck, and mediastinum. However, the presence of an AVF or AVG ipsilateral to a central venous stenosis or occlusion can overwhelm the collateral network due to the significantly elevated blood flow. This may result in severe and debilitating upper extremity and fascial swelling. While ligation results in almost instantaneous symptomatic relief, it does not address the patient's underlying pathologic process and necessitates an additional access. As these patients continue to live longer, our strategies to manage these failing accesses are becoming increasingly complex. The goal of preserving existing access while correcting any symptoms is paramount. Previous case reports have documented various surgical options for preserving an existing access. CASE PRESENTATION Our patient is a 49-year-old female with hypertension and end-stage renal disease, on hemodialysis through a right arm arteriovenous (AV) fistula. She had a history of multiple AV fistulae creations in the past, all of which previously thrombosed. Several years after the creation of her most recent fistula, she developed severe throbbing headaches, right arm and facial swelling, right eye lacrimation, and blurry vision. AV fistula angiogram demonstrated right brachiocephalic vein chronic occlusion and endovascular revascularization through both trans-AVF and transfemoral approaches were attempted, but unsuccessful. DISCUSSION This case illustrates the success of the creation of an internal jugular-jugular vein bypass to maintain a right arm arteriovenous fistula, while at the same time, correcting the symptoms of a right brachiocephalic vein occlusion.
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Affiliation(s)
- Jared Carleton
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jason Chang
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Qinghua Richard Pu
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Robert Rhee
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Bechara CF. Invited Commentary Open Venous Bypass in the Era of Endovascular Therapy. Ann Vasc Surg 2021; 74:330. [PMID: 33684511 DOI: 10.1016/j.avsg.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
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Yang L, Yang L, Zhao Y, Wang Y, Yu Y, Salerno S, Li Y, Fu P, Cui T. The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study. Hemodial Int 2019; 24:52-60. [PMID: 31808994 DOI: 10.1111/hdi.12804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ling Yang
- Outpatient DepartmentWest China Hospital of Sichuan University Chengdu China
| | - Letian Yang
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yuliang Zhao
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Yating Wang
- Department of Internal MedicineLouis A Weiss Memorial Hospital Chicago Illinois USA
| | - Yang Yu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Stephen Salerno
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
| | - Yi Li
- Department of BiostatisticsSchool of Public Health, University of Michigan Ann Arbor Michigan USA
- Kidney Epidemiology and Cost CenterUniversity of Michigan Ann Arbor Michigan USA
| | - Ping Fu
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
| | - Tianlei Cui
- Division of NephrologyWest China Hospital of Sichuan University Chengdu China
- Kidney Research InstituteWest China Hospital of Sichuan University Chengdu China
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DeGiovanni J, Son A, Salehi P. Transposition of external jugular to proximal internal jugular vein for relief of venous thoracic outlet syndrome and maintenance of arteriovenous fistula access for chronic hemodialysis: A new approach. J Vasc Access 2019; 21:98-102. [PMID: 31232170 DOI: 10.1177/1129729819851063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We are reporting a case of venous thoracic outlet syndrome with recurrent subclavian vein thrombosis in the setting of an ipsilateral brachiocephalic arteriovenous fistula for hemodialysis that was malfunctioning due to the central vein obstruction. The patient also had a concomitant external jugular vein origin stenosis. Given her body habitus and aversion to recovery after traditional first rib resection, we elected for an alternative treatment with an external jugular vein to internal jugular vein transposition with balloon angioplasty of the stenosed external jugular origin segment. The goal of this was to provide simultaneous relief of her outlet obstruction symptoms and salvage her dialysis access with a less invasive technique.
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Affiliation(s)
| | - Andrew Son
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Payam Salehi
- Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Tufts Medical Center, Boston, MA, USA
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Lopez-Pena G, Anaya-Ayala JE, Garcia-Alva R, Luna L, Lizola R, Cuen-Ojeda C, Arzola LH, Hinojosa CA. Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation. J Vasc Access 2019; 21:55-59. [PMID: 31188045 DOI: 10.1177/1129729819851919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. METHODS This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients' demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. RESULTS Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). CONCLUSION Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.
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Affiliation(s)
- Gabriel Lopez-Pena
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ramon Garcia-Alva
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Lizeth Luna
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rene Lizola
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Cesar Cuen-Ojeda
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Luis H Arzola
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Carlos A Hinojosa
- Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Inston N, Khawaja A, Mistry H, Jones R, Valenti D. Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft? J Vasc Access 2019; 21:7-18. [DOI: 10.1177/1129729819841153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options. Three options for patients with end stage access are a central venous catheter through a translumbar or transhepatic route, arterial-arterial prosthetic loop or a right atrial graft. Aims: The aims of this study are to provide a structured review of evidence for these procedures to allow application and guide practice for patients with end stage vascular access. Methods: A standardised search of published literature was performed of relevant studies. In addition, the references cited in those papers were assessed for any further available articles. All study types were included and reviewed by two authors independently. Primary outcomes were patient survival and secondary patency rate at 3 and 12 months. Secondary outcomes were long-term patency rates, mean time to cannulation and complications such as access dysfunction, thrombosis and infection. Summary: Based on the available evidence, it would appear that arterial-arterial prosthetic loop is a definitive option for maintaining dialysis access in patients with no more arteriovenous access options. Translumbar and transhepatic dialysis catheters may offer short- and medium-term options and right atrial grafts may also be suitable as an option where arterial-arterial prosthetic loop is unsuitable.
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Affiliation(s)
- Nicholas Inston
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aurangzaib Khawaja
- Department of Renal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hiren Mistry
- Department of Vascular Surgery, King’s College Hospital, London, UK
| | - Robert Jones
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Domenico Valenti
- Department of Vascular Surgery, King’s College Hospital, London, UK
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Wooster M, Fernandez B, Summers KL, Illig KA. Surgical and endovascular central venous reconstruction combined with thoracic outlet decompression in highly symptomatic patients. J Vasc Surg Venous Lymphat Disord 2019; 7:106-112.e3. [DOI: 10.1016/j.jvsv.2018.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 10/27/2022]
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Success Rate and Complications of Sharp Recanalization for Treatment of Central Venous Occlusions. Cardiovasc Intervent Radiol 2017; 41:73-79. [PMID: 28879566 DOI: 10.1007/s00270-017-1787-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate success and safety of needle (sharp) recanalization as a method to re-establish access in patients with chronic central venous occlusions. MATERIALS AND METHODS Thirty-nine consecutive patients who underwent this procedure were retrospectively reviewed to establish success rate and associated complications. In all cases, a 21- or 22-gauge needle was used to restore connection between two chronically occluded segments after conventional wire and catheter techniques had failed. The needle was guided toward a target placed through a separate access by fluoroscopic guidance. When successful, the procedure was completed by placing a catheter, ballooning the segment, and/or stenting. RESULTS The procedure was successful in 37 of the 39 patients (95%). The vast majority of the treated lesions were in the SVC and/or right innominate vein. Occlusions ranged in length between 10 and 110 mm, and the average length of occluded venous segment was 40 mm in the treated group. There were four minor (SIR classification B) complications involving pain management after the procedure. There were two major (SIR classification D) complications both of which involved hemorrhage into the pericardium treated with covered stents (5.1%). CONCLUSIONS Sharp recanalization is a viable procedure for patients who have exhausted standard wire and catheter techniques. The operator performing this procedure should be familiar with potential complications so that they can be addressed urgently if needed.
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Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses. J Vasc Access 2017; 18:e39-e41. [DOI: 10.5301/jva.5000656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2016] [Indexed: 11/20/2022] Open
Abstract
Background Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion. Methods We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy. Results Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access. Conclusions Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.
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The Use of HeRo Catheter in Catheter-dependent Dialysis Patients with Superior Vena Cava Occlusion. J Vasc Access 2016; 17:138-42. [DOI: 10.5301/jva.5000493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives Hemodialysis (HD) patients with superior vena cava (SVC) occlusion have limited access options. Femoral access is commonly employed but is associated with high complication rates. Hemodialysis Reliable Outflow (HeRO) catheters can be used in tunneled catheter-dependent (TCD) patients who have exhausted other access options. The HeRO graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. At our institution we have used the inside-out central venous access technique (IOCVA) to traverse an occluded vena cava for HeRO graft placement. We review our experience with this technique. Methods A retrospective chart review was conducted of patients with HeRO graft placement at our institution. All were dependent on a tunneled femoral dialysis catheter due to central venous occlusion (CVO). The IOCVA technique was used in each case. This technique was used as last resort for patients who had no other dialysis access option. Demographics, patency rates, complications, and mortality were recorded. Results A total of 11 HeRO grafts were placed in 11 patients from January 2012 to June 2013, with 100% technical success rate. Three grafts were ligated due to steal syndrome. Two grafts were lost due to thrombosis. Five of 11 patients experienced a 30-day complication. Three patients died within the follow-up period; however, none were directly related to the graft placement. Follow up range was 65-573 days; 5 of 11 grafts were used for dialysis at the end of the follow-up period. The 12-month patency rate was 30%. Conclusions HeRO grafts are one option for dialysis patients with CVO. There is, however, a high incidence of steal syndrome and other complications. These grafts should be offered as a final potential alternative to catheter dependence.
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Arabi M, Ahmed I, Mat’hami A, Ahmed D, Aslam N. Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience. Cardiovasc Intervent Radiol 2015; 39:927-34. [DOI: 10.1007/s00270-015-1270-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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Surgical Options in the Problematic Arteriovenous Haemodialysis Access. Cardiovasc Intervent Radiol 2015; 38:1405-15. [DOI: 10.1007/s00270-015-1155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/30/2015] [Indexed: 11/27/2022]
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Unusual sites for hemodialysis vascular access construction and catheter placement: A review. Int J Artif Organs 2015; 38:293-303. [PMID: 26242845 DOI: 10.5301/ijao.5000416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
As more end-stage renal disease patients require hemodialysis and live longer, many will fail to develop or maintain a functioning upper extremity vascular access. When a patient exhausts vascular access sites in the upper extremities, new fistulas and grafts can be constructed in the lower extremities, thorax, and abdomen as long as a pair of proximate artery and vein provide adequate blood inflow and outflow, respectively. When only a moderate size vein with adequate blood flow provides a conduit to either a patent superior or inferior vena cava, inserting a double-lumen venous hemodialysis catheter can provide temporary or permanent access. We review the literature and report the unusual sites for hemodialysis vascular access and catheter placement.
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Skupien FJ, Gomes RZ, Shimada EH, Brandao RI, Skupien SV. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL), few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.
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Glass C, Dugan M, Gillespie D, Doyle A, Illig K. Costoclavicular Venous Decompression in Patients With Threatened Arteriovenous Hemodialysis Access. Ann Vasc Surg 2011; 25:640-5. [DOI: 10.1016/j.avsg.2010.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/04/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
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Illig KA. Management of Central Vein Stenoses and Occlusions: The Critical Importance of the Costoclavicular Junction. Semin Vasc Surg 2011; 24:113-8. [DOI: 10.1053/j.semvascsurg.2011.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vascular Access Flow Reduction for Arteriovenous Fistula Salvage in Symptomatic Patients with Central Venous Occlusion. J Vasc Access 2011; 13:157-62. [DOI: 10.5301/jva.5000020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose Vascular access patients with central vein (CV) stenosis or occlusion may have significant symptoms. Treatment is generally by balloon angioplasty, with or without stenting. However, CV lesions may not be correctable and when treated, tend to recur. Surgical bypass of CV obstruction is a major procedure and ligation of the access may leave the patient dependent on catheter dialysis. We review a precision inflow banding procedure to limit vascular access flow and pressure for symptomatic patients with CV obstruction while preserving access functionality. Materials and Methods All individuals with symptomatic CV occlusive disease who underwent an autogenous vascular access inflow restriction procedure by the two senior authors were identified. All had failed attempts to correct CV lesions by angioplasty and stent placement. A precision banding procedure was used for access inflow reduction with the addition of real-time intravascular flow monitoring. Results Twenty-two patients were identified. Ages were 22–72 years (mean=43 years). Nine patients (40.9%) were women, and 8 (36.4%) obese. Mean access flow was 1640 mL/minute before banding decreased to 820 mL/minute after banding (P<.01). All patients had access salvage. Swelling resolved promptly in 20 patients and was markedly improved in two individuals. Three patients underwent aneurysm repair with simultaneous inflow banding and decreased intra-access pressure after flow restriction. Two fistulas failed at eight and 13 months. Mean follow-up was 8 months. Conclusions The symptoms of hemodialysis vascular access patients associated with non-correctable central venous lesions resolved successfully and their access was maintained using a precision inflow banding procedure.
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Combined Femoral Vein Transposition and Iliac Vein to Suprarenal Vena Cava Bypass as a Last Resort Dialysis Access. Ann Vasc Surg 2011; 25:264.e5-8. [DOI: 10.1016/j.avsg.2010.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/22/2010] [Accepted: 03/27/2010] [Indexed: 11/20/2022]
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Anaya-Ayala JE, Bellows PH, Ismail N, Cheema ZF, Naoum JJ, Bismuth J, Lumsden AB, Reardon MJ, Davies MG, Peden EK. Surgical Management of Hemodialysis-Related Central Venous Occlusive Disease: A Treatment Algorithm. Ann Vasc Surg 2011; 25:108-19. [DOI: 10.1016/j.avsg.2010.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/11/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
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Glass C, Porter J, Singh M, Gillespie D, Young K, Illig K. A Large-Scale Study of the Upper Arm Basilic Transposition for Hemodialysis. Ann Vasc Surg 2010; 24:85-91. [DOI: 10.1016/j.avsg.2009.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 05/12/2009] [Accepted: 05/21/2009] [Indexed: 11/25/2022]
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