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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.
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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
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Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 913] [Impact Index Per Article: 228.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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RAHMANI SHAHROKH, EBRAHIMI BEHDADSHAARBAF, HEIDARI ALIREZA, NAVIDBAKHSH MAHDI, ALIZADEH MANSOUR, TAFTI HOSSEINAHMADI. HEMODYNAMIC INVESTIGATION OF SUBCLAVIAN-CORONARY STEAL SYNDROME IN DIALYSIS PATIENTS WITH CORONARY ARTERY OCCLUSION AND DIFFERENT STENOSIS PERCENTAGES IN SUBCLAVIAN ARTERY. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: Diseases of the coronary arteries represent critical cardiovascular bleakness and mortality around the world. The main focus of this study is to simulate hemodialysis patients undergoing Coronary Artery Bypass Graft (CABG) surgery by the left internal mammary artery. The survey is to investigate whether subclavian-coronary steal syndrome will occur in patients with stenosis in their left subclavian. Methods: A three-dimensional model of Brachial—Radial—Ulnar tree arterial system and dialysis graft are constructed and then simulated by the implementation of fluid–structure interaction (FSI) and non-FSI models. After consent was obtained, data attributed to dialysis patients who had undergone coronary bypass surgery at the Tehran Heart Center (THD) was collected. Results: Stenosis in the subclavian artery causes the left internal mammary artery (LIMA) graft to lack flow that, in CABG cases, is supplying the heart muscle. With the increase of stenosis from zero to 54%, the flow results show a negative flow indicating reversed flow in the artery. Meanwhile, the comparison between flow quantity of a normal Left Anterior Descending (LAD) and LIMA in case of 38% stenosis in subclavian shows that the amount of flow reaching the heart is less than standard. The threshold stenosis in the subclavian artery for which subclavian-coronary steal phenomena occurs is simulated to be around 54%. Furthermore, investigation of the effect of flow quantity in cases of hemodialysis versus nonhemodialysis shows that the flow is lessened in case of hemodialysis. Conclusions: In hemodialysis patients with more than 38% stenosis in left subclavian, it is well advised that LIMA bypass graft is not the preferred graft choice, and at 54% of subclavian stenosis, the steal phenomenon occurs.
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Affiliation(s)
- SHAHROKH RAHMANI
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran 16846, Iran
| | - BEHDAD SHAARBAF EBRAHIMI
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran 16846, Iran
- Bioengineering Faculty, University of Auckland, New Zealand
| | - ALIREZA HEIDARI
- Structural Engineering, School of Civil Engineering, Faculty of Engineering, University of Tehran, Iran
| | - MAHDI NAVIDBAKHSH
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran 16846, Iran
| | - MANSOUR ALIZADEH
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran 16846, Iran
| | - HOSSEIN AHMADI TAFTI
- Department of Cardiac Surgery, Tehran University of Medical Sciences, Tehran 14167, Iran
- Department of Cardiac Surgery, Tehran Heart Center, Tehran 14117, Iran
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Fominykh NM, Zulkarnaev AB, Gegenava BB, Kardanakhishvili ZB. [Endovascular embolization of arteriovenous fistula in a patient with hand ischemia]. Khirurgiia (Mosk) 2019:111-116. [PMID: 31317950 DOI: 10.17116/hirurgia2019061111] [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: 11/17/2022]
Abstract
We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.
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Affiliation(s)
- N M Fominykh
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A B Zulkarnaev
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - B B Gegenava
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Z B Kardanakhishvili
- Department of transplantology, nephrology and artificial organs, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
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Krishna VN, Eason JB, Allon M. Central Venous Occlusion in the Hemodialysis Patient. Am J Kidney Dis 2016; 68:803-807. [DOI: 10.1053/j.ajkd.2016.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/27/2016] [Indexed: 11/11/2022]
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Sandler N, Sharpin C, Bhagwat K, Ma R, Yii M, Almeida A. Stenting of the Brachiocephalic Vein Following Occlusion After Coronary Artery Bypass Surgery. J Card Surg 2016; 31:432-4. [PMID: 27282334 DOI: 10.1111/jocs.12765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a case of left arm swelling over nine months post coronary artery bypass grafting (CABG), due to occlusion of the left brachiocephalic vein. The patient's perioperative course, diagnosis, and management of this complication are presented. doi: 10.1111/jocs.12765 (J Card Surg 2016;31:432-434).
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Affiliation(s)
- Nicola Sandler
- Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Claire Sharpin
- Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Krishna Bhagwat
- Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Robert Ma
- Department of Vascular Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Ming Yii
- Department of Vascular Surgery, Monash Medical Centre, Clayton, Victoria, Australia
| | - Aubrey Almeida
- Department of Cardiothoracic Surgery, Monash Medical Centre, Clayton, Victoria, Australia
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