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Wu CK, Tarng DC, Yang CY, Leu JG, Lin CH. Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study. BMJ Open 2022; 12:e055763. [PMID: 35074822 PMCID: PMC8788314 DOI: 10.1136/bmjopen-2021-055763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Maintenance of vascular access (VA) patency after percutaneous transluminal angioplasty (PTA) is important and remains a challenge despite VA monitoring and surveillance. The aim of this study was to examine factors affecting the post-PTA arteriovenous access (AVA) patency in patients who have been on close VA monitoring and surveillance for access flow. DESIGN Retrospective cohort study. SETTING A single medical centre in Taiwan. PARTICIPANTS Records of patients who received chronic haemodialysis between 1 January 2017 and 31 December 2018 were retrospectively reviewed. Patients were divided into two groups (without or with PTA intervention on AVA). PRIMARY AND SECONDARY OUTCOME Patients were followed until reintervention PTA, termination or abandoned VA or end of study. In addition to routine monitoring, VA flow surveillance was performed every 3 months for detection of VA dysfunction adhering to Kidney Disease Outcomes Quality Initiative guidelines. RESULTS A total of 508 patients were selected for study inclusion (with PTA, n=231; without PTA, n=277). At baseline, variables that differed between groups included malignancy and levels of albumin, uric acid, potassium, phosphorous, high-density lipoprotein, total bilirubin and ferritin (all p<0.05). Significant between-group differences were observed for β-adrenergic blocking agents (with PTA, 49.8%; without PTA, 37.5%; p, 0.007) and ADP inhibitors (with PTA, 23.8%; without PTA, 11.2%; p<0.001). Among patients with PTA, those with acute myocardial infarction, high ferritin level or arteriovenous graft (AVG) had a significantly higher risk of reintervention post-PTA (p<0.05). Dipeptidyl peptidase-4 inhibitors, thiazolidinediones, ADP inhibitors, and warfarin use were predictors of post-PTA patency (p<0.05). CONCLUSIONS AVG access type, acute myocardial infarction, and high ferritin levels are risk factors for re-intervention post-PTA. These findings may be useful in the development of prophylactic strategies for monitoring VA function and tailoring surveillance programs for these dialysis patients.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- Dialysis Access Management Center, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Der-Cherng Tarng
- Department of Institute of Physiology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Gang Leu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Chia-Hsun Lin
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
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Shiu YT, He Y, Tey JCS, Knysheva M, Anderson B, Kauser K. Natural Vascular Scaffolding Treatment Promotes Outward Remodeling During Arteriovenous Fistula Development in Rats. Front Bioeng Biotechnol 2021; 9:622617. [PMID: 33681159 PMCID: PMC7928390 DOI: 10.3389/fbioe.2021.622617] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Following creation, an arteriovenous fistula (AVF) must mature (i.e., enlarge lumen to allow high blood flow) before being used for hemodialysis. AVF maturation failure rates are high, and currently, there are no effective therapy to treat this problem. The maturation process is likely affected by the integrity of the vascular extracellular matrix (ECM). Natural Vascular Scaffolding (NVS) Therapy is a new technology that interlinks collagen and elastin via photoactivation of a locally delivered small molecule (4-amino-1,8-naphtalamide). We hypothesized that NVS Therapy may improve AVF remodeling by preserving ECM integrity. AVFs were created in Wistar male rats by connecting the femoral vein (end) to femoral artery (side) in the same limb. Immediately after blood flow was restored to dilate the femoral vein by arterial pressure, a 10 μl-drop of the NVS compound (2 mg/ml) was placed on the anastomosis perivascularly. Following 5-min incubation, the NVS treated area was exposed to 1-min illumination by 450-nm light. The control group received 10 μl-drop of phosphate buffered saline (PBS) and the same light activation. The skin was closed, and rats were euthanized 4 weeks (n = 6-9 per group) post-AVF creation for histology, morphometry, immunohistochemistry (IHC), and multiphoton microscopy for second-harmonic-generation evaluation of collagen fibers. The vascular thickness was similar in both groups. The AVF vein's open lumen area and % open lumen area in NVS-treated rats were significantly larger than in PBS-treated rats (4.2-fold p = 0.014 and 2-fold p = 0.009, respectively). The inflammatory markers IL-6 and MMP-9 in the AVF walls were significantly decreased in the NVS group than the PBS group. Collagen fibers in the vascular wall trended toward perpendicular alignment to the lumen circumference in the NVS-treated AVFs, with more defined shape but less area than in the PBS-treated AVFs. These results indicate that the NVS Therapy exerted changes in collagen, which may influence AVF maturation. Rats tolerated the NVS treatment well, and the lack of cell death by the treatment was confirmed in cell culture experiments. These results suggest that NVS treatment is safe and may have therapeutic potential by facilitating lumen expansion to enhanced AVF maturation in patients.
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Affiliation(s)
- Yan-Ting Shiu
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United States.,Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Yuxia He
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jason C S Tey
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Marina Knysheva
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Blake Anderson
- Alucent Biomedical Inc., Salt Lake City, UT, United States
| | - Katalin Kauser
- Alucent Biomedical Inc., Salt Lake City, UT, United States
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Wu CC, Chen LJ, Hsieh MY, Lo CM, Lin MH, Tsai HE, Song HL, Chiu JJ. MicroRNA-21 and Venous Neointimal Hyperplasia of Dialysis Vascular Access. Clin J Am Soc Nephrol 2018; 13:1712-1720. [PMID: 30242025 PMCID: PMC6237050 DOI: 10.2215/cjn.02410218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES There is increasing evidence that microRNAs (miRNAs) play crucial roles in the regulation of neointima formation. However, the translational evidence of the role of miRNAs in dialysis vascular access is limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS miRNA expression in tissues was assessed by using venous tissues harvested from ten patients on dialysis who received revision or removal surgery, and ten patients who were predialysis and received creation surgery of arteriovenous fistulas served as controls. To extend these findings, 60 patients who received angioplasty of dialysis access were enrolled and the levels of circulating miRNAs were determined before and 2 days after angioplasty. Clinical follow-up was continued monthly for 6 months. The primary outcome of angioplasty cohort was target lesion restenosis within 6 months after angioplasty. RESULTS In the surgery cohort, the expressions of miR-21, miR-130a, and miR-221 were upregulated in stenotic tissues, whereas those of miR-133 and miR-145 were downregulated. In situ hybridization revealed similar expression patterns of these miRNAs, localized predominantly in the neointima region. Twenty eight patients in the angioplasty cohort developed restenosis within 6 months. The levels of circulating miR-21, miR-130a, miR-221, miR-133, and miR-145 significantly increased 2 days after angioplasty. Kaplan-Meier plots showed that patients with an increase of miR-21 expression level >0.35 have a higher risk of patency loss (hazard ratio, 4.45; 95% confidence interval, 1.68 to 11.7). In a multivariable analysis, postangioplasty increase of miR-21 expression was independently associated with restenosis (hazard ratio, 1.20; 95% confidence interval, 1.07 to 1.35 per one unit increase of miR-21 expression level; P=0.001). CONCLUSIONS Certain miRNAs are differentially expressed in the stenotic venous segments of dialysis accesses. An increase in blood miR-21 level with angioplasty is associated with a higher risk of restenosis.
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Affiliation(s)
- Chih-Cheng Wu
- Cardiovascular Center
- College of Medicine and
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
| | - Li-Jing Chen
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli, Taiwan; and
| | | | - Chien-Ming Lo
- Division of Cardiovascular Surgery, Department of Surgery, and
| | - Ming-Hsien Lin
- Division of Cardiovascular Surgery, Department of Surgery, and
| | - Hsiao-En Tsai
- Division of Cardiovascular Surgery, Department of Surgery, and
| | - Hsiang-Lin Song
- Department of Surgical Pathology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Jeng-Jiann Chiu
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli, Taiwan; and
- College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Dolmatch B, Hogan A, Ferko N. An Economic Analysis of Stent Grafts for Treatment of Vascular Access Stenosis: Point-of-Care and Medicare Perspectives in the United States. J Vasc Interv Radiol 2018; 29:765-773.e2. [PMID: 29706343 DOI: 10.1016/j.jvir.2018.01.777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To conduct an economic analysis on the impact of increased stent graft (SG) use for treatment of arteriovenous graft (AVG) anastomotic stenosis or arteriovenous fistula (AVF)/AVG in-stent restenosis (ISR) from United States point-of-care (POC) and Medicare perspectives. MATERIALS AND METHODS The analyses compared initial device and reintervention costs over 2 years between current and projected treatment mixes, including percutaneous transluminal angioplasty (PTA), bare metal stents (BMSs), and SGs. In projected scenarios, the absolute increase in SG use was approximately 3%. Costs included procedure reimbursement rates (Medicare) and device list prices (POC) for index procedures and reinterventions. Reintervention rates and types were informed by the RENOVA and RESCUE randomized trials. Reinterventions were primarily PTA only; however, stent use occurred a proportion of the time. BMS reintervention rates were assumed to be identical to PTA based on observational data. A population size of 1,000 patients was assumed. RESULTS To the POC (n = 1,000), increased SG use was predicted to result in cost savings ranging from $4,106 to $34,420 for AVG anastomotic stenosis. For AVF/AVG ISR, increased SG use was predicted to result in either a cost increase of $17,187 or a cost savings of $13,159. To Medicare (n = 1,000), increased SG use was predicted to save costs for both populations, with savings ranging from $57,401 to $169,544. CONCLUSIONS The use of SG for treatment of AVG anastomotic stenosis and AVF/AVG ISR appears to be economically favorable for POC providers and Medicare. Further data on reintervention rates are required from other SG trials to validate findings.
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Affiliation(s)
- Bart Dolmatch
- Department of Interventional Radiology, The Palo Alto Medical Foundation, Mountain View, California
| | - Andrew Hogan
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada
| | - Nicole Ferko
- Cornerstone Research Group Inc., 3228 S Service Rd, Burlington, ON L7N 3H8, Canada.
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Boire TC, Balikov DA, Lee Y, Guth CM, Cheung-Flynn J, Sung HJ. Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures. Macromol Rapid Commun 2016; 37:1860-1880. [PMID: 27673474 PMCID: PMC5156561 DOI: 10.1002/marc.201600412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/15/2016] [Indexed: 12/19/2022]
Abstract
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions. Numerous studies have demonstrated the ability of external stents to reduce neointimal hyperplasia. However, successful results from animal models have failed to translate to the clinic thus far, and no external stent is currently approved for use in the US to prevent vein graft or hemodialysis access failures. This review discusses current progress in the field, design considerations, and future perspectives for biomaterial-based external stents. More comparative studies iteratively modulating biomaterial and biomaterial-drug approaches are critical in addressing mechanistic knowledge gaps associated with external stent application to the arteriovenous environment. Addressing these gaps will ultimately lead to more viable solutions that prevent vein graft and hemodialysis access failures.
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Affiliation(s)
- Timothy C Boire
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Daniel A Balikov
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Yunki Lee
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Christy M Guth
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Hak-Joon Sung
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
- Severance Biomedical Science Institute, College of Medicine, Yonsei University, Seoul, 120-752, Republic of Korea
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Lee T, Misra S. New Insights into Dialysis Vascular Access: Molecular Targets in Arteriovenous Fistula and Arteriovenous Graft Failure and Their Potential to Improve Vascular Access Outcomes. Clin J Am Soc Nephrol 2016; 11:1504-1512. [PMID: 27401527 PMCID: PMC4974876 DOI: 10.2215/cjn.02030216] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Vascular access dysfunction remains a major cause of morbidity and mortality in hemodialysis patients. At present there are few effective therapies for this clinical problem. The poor understanding of the pathobiology that leads to arteriovenous fistula (AVF) and graft (AVG) dysfunction remains a critical barrier to development of novel and effective therapies. However, in recent years we have made substantial progress in our understanding of the mechanisms of vascular access dysfunction. This article presents recent advances and new insights into the pathobiology of AVF and AVG dysfunction and highlights potential therapeutic targets to improve vascular access outcomes.
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Affiliation(s)
- Timmy Lee
- Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
- Veterans Affairs Medical Center, Birmingham, Alabama; and
| | - Sanjay Misra
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Choi SJ, Cho EH, Jo HM, Min C, Ji YS, Park MY, Kim JK, Hwang SD. Clinical utility of far-infrared therapy for improvement of vascular access blood flow and pain control in hemodialysis patients. Kidney Res Clin Pract 2015; 35:35-41. [PMID: 27069856 PMCID: PMC4811988 DOI: 10.1016/j.krcp.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 01/01/2023] Open
Abstract
Background Maintenance of a well-functioning vascular access and minimal needling pain are important goals for achieving adequate dialysis and improving the quality of life in hemodialysis (HD) patients. Far-infrared (FIR) therapy may improve endothelial function and increase access blood flow (Qa) and patency in HD patients. The aim of this study was to evaluate effects of FIR therapy on Qa and patency, and needling pain in HD patients. Methods This prospective clinical trial enrolled 25 outpatients who maintained HD with arteriovenous fistula. The other 25 patients were matched as control with age, sex, and diabetes. FIR therapy was administered for 40 minutes during HD 3 times/wk and continued for 12 months. The Qa was measured by the ultrasound dilution method, whereas pain was measured by a numeric rating scale at baseline, then once per month. Results One patient was transferred to another facility, and 7 patients stopped FIR therapy because of an increased body temperature and discomfort. FIR therapy improved the needling pain score from 4 to 2 after 1 year. FIR therapy increased the Qa by 3 months and maintained this change until 1 year, whereas control patients showed the decrease in Qa. The 1-year unassisted patency with FIR therapy was not significantly different from control. Conclusion FIR therapy improved needling pain. Although FIR therapy improved Qa, the unassisted patency was not different compared with the control. A larger and multicenter study is needed to evaluate the effect of FIR therapy.
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Affiliation(s)
- Soo Jeong Choi
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
- Corresponding author. Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Jung-dong, Wonmi-gu, Bucheon, Gyunggi, 420-767, Korea.
| | - Eun Hee Cho
- Artificial Kidney Unit, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hye Min Jo
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Changwook Min
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Sok Ji
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Moo Yong Park
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jin Kuk Kim
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Duk Hwang
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
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Taylor MJ, Hanson CS, Casey JR, Craig JC, Harris D, Tong A. “You know your own fistula, it becomes a part of you”-Patient perspectives on vascular access: A semistructured interview study. Hemodial Int 2015. [DOI: 10.1111/hdi.12340] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew J. Taylor
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Camilla S. Hanson
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Jordan R. Casey
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan C. Craig
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
| | - David Harris
- Department of Renal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Allison Tong
- Centre for Kidney Research; The Children's Hospital at Westmead; Sydney New South Wales Australia
- Sydney School of Public Health; The University of Sydney; Sydney New South Wales Australia
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Florescu MC, Foster KW, Sacks AR, Lof J, Stolze EA, Fry GM, Bumgardner DP, Tysinger T, Kuchta MJ, Runge HJ, Hadley WB, Morris MC. Sheep Model of Hemodialysis Arteriovenous Fistula Using Superficial Veins. Semin Dial 2015; 28:687-91. [DOI: 10.1111/sdi.12407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marius C. Florescu
- Section of Nephrology; University of Nebraska Medical Center; Omaha Nebraska
| | - Kirk W. Foster
- Pathology Department; University of Nebraska Medical Center; Omaha Nebraska
| | - Andrew R. Sacks
- Section of Nephrology; University of Nebraska Medical Center; Omaha Nebraska
| | - John Lof
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Elizabeth A. Stolze
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Gretchen M. Fry
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Derek P. Bumgardner
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Tara Tysinger
- Vascular Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Melanie J. Kuchta
- Vascular Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Henry J. Runge
- UNEMED; University of Nebraska Medical Center; Omaha Nebraska
| | | | - Michael C. Morris
- Section of Kidney and Pancreas Transplant Surgery; University of Nebraska Medical Center; Omaha Nebraska
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Krycińska R, Trznadel A, Kuchalska P, Lis M, Dołęga-Kozierowski B, Dyś K, Drelichowski S, Witkiewicz W. Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient - Case Report and Literature Review. Pol J Radiol 2015; 80:247-51. [PMID: 26000070 PMCID: PMC4432621 DOI: 10.12659/pjr.893358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/23/2015] [Indexed: 11/24/2022] Open
Abstract
Background Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains. Case Report 61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by “body floss” technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self – expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center. Conclusions Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.
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Affiliation(s)
- Róża Krycińska
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Agata Trznadel
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Paulina Kuchalska
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Michał Lis
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Bartosz Dołęga-Kozierowski
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Krzysztof Dyś
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Stanisław Drelichowski
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
| | - Wojciech Witkiewicz
- Lower Silesian Centre for Diagnostic Imaging, Hospital to the Wrocław Centre for Research and Development, Wrocław, Poland
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