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Zhang L, Zhan S, Zhang F, Zhao B, Hou F, Wang Y. Recanalization of a long segment occluded superior vena cava by puncturing the remnant calcified fibrin sheath of the internal jugular vein: A case report. J Vasc Access 2024:11297298241259520. [PMID: 38884336 DOI: 10.1177/11297298241259520] [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: 06/18/2024] Open
Abstract
A fibrin sheath with central venous occlusion is a common complication after central venous catheterization, and these patients often experience catheter dysfunction. A calcified fibrin sheath can cause a catheter to be stuck, and typically necessitates catheter removal or replacement. From another point of view, a calcified fibrin sheath can be seen in ultrasound and computed tomography, and the original fibrin sheath channel between the internal jugular vein and the atrium is unusually strong. When central vein occlusion occurs, the remnant calcified fibrin sheath of the internal jugular vein can be punctured under ultrasound guidance, allowing the guidewire to enter the atrium directly through the fibrin sheath. Here, we report a case in which we achieved easy recanalization of a long segment occluded superior vena cava by puncturing the remnant calcified fibrin sheath of the internal jugular vein.
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Affiliation(s)
- Lihong Zhang
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
| | - Shen Zhan
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
| | - Fan Zhang
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
| | - Bin Zhao
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
| | - Fang Hou
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
| | - Yuzhu Wang
- Department of Nephrology, Haidian Hospital (Haidian section of Peking University Third Hospital), Beijing, China
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Yamamoto S, Kamezaki M, Ooka J, Mazaki T, Shimoda Y, Nishihara T, Adachi Y. Balloon venoplasty for disdialysis syndrome due to pacemaker-related superior vena cava syndrome with chylothorax post-bacteraemia: A case report. World J Clin Cases 2023; 11:8364-8371. [PMID: 38130610 PMCID: PMC10731190 DOI: 10.12998/wjcc.v11.i35.8364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/21/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Although superior vena cava (SVC) syndrome has also been reported as a late complication of pacemaker (PM) implantation, acute onset of SVC syndrome caused by disdialysis syndrome in patients with PM implantation is very rare. There are no specific therapies or guidelines. CASE SUMMARY A 96-year-old woman receiving dialysis was implanted with a PM due to sick sinus syndrome. She was referred to our facility for chest discomfort experienced during dialysis. Upon examination, unilateral pleural effusion on the right side was cloudy with a foul odour. The patient was diagnosed with pyothorax and treated with antibiotics. After the effusion was reduced, it gradually reaggravated and remained cloudy. In this case, SVC syndrome, which is generally considered a late complication after PM implantation, rapidly developed following the bacteraemia, resulting in impaired venous return, chylothorax, and disdialysis syndrome. After catheter intervention for SVC stenosis, the patient's symptoms promptly improved. The patient has been recurrence-free for a year. CONCLUSION Acute SVC syndrome can cause dysdialysis in PM-implanted patients. Catheter intervention alone has improved this condition for a traceable period.
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Affiliation(s)
- Satomi Yamamoto
- Department of Nephrology, Kobe Central Hospital, Kobe 651-1145, Japan
| | | | - Junichi Ooka
- Department of Cardiology, Kobe Central Hospital, Kobe 651-1145, Japan
| | - Toru Mazaki
- Department of Cardiology, Kobe Central Hospital, Kobe 651-1145, Japan
| | - Yoshiaki Shimoda
- Department of Cardiology, Kobe Central Hospital, Kobe 651-1145, Japan
| | - Takaaki Nishihara
- Department of Nephrology, Kobe Central Hospital, Kobe 651-1145, Japan
| | - Yoko Adachi
- Department of Nephrology, Kobe Central Hospital, Kobe 651-1145, Japan
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Wang Z, Li T, Zhou J, Yu Y, Chen Y, Fu P. Patient-specific hemodynamic feature of central venous disease intervened by stent: A numerical study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3737. [PMID: 37269226 DOI: 10.1002/cnm.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/13/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
Central venous disease (CVD) with stenosis or occlusion is a severe and prevalent complication for chronic hemodialysis (HD) patients, resulting in dialysis access dysfunction. Percutaneous transluminal angioplasty with stent placement (PTS) has become one of the first-line treatments for CVD. In clinical practice, the extra stents would be used if the curative efficacy of a single stent were unsatisfactory. Aiming to evaluate the therapeutic effect of different PTS schemes, computational fluid dynamics (CFD) simulations on four patients were performed to compare the hemodynamic characteristics of real-life HD patients after stent placement. The three-dimensional central vein's models of each patient were built using computational tomography angiography (CTA) images, and idealized models were constructed as contrast. Two inlet velocity modes were imposed to imitate the blood flow rate of healthy and HD patients. The hemodynamic parameters for different patients were investigated, including wall shear stress (WSS), velocity, and helicity. The results showed that the implantation of double stents is able to improve flexibility. When subjected to external force, the double stents have better radial stiffness. This paper evaluated the therapeutic efficacy of stent placement and provided a theoretical basis for CVD intervention in hemodialysis patients.
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Affiliation(s)
- Zhaoli Wang
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Tao Li
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Jingyuan Zhou
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Yang Yu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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Lee KN, Chen CA, Wu CH, Yang LY. Reduction in hemodialysis catheter-related bloodstream infections after implementation of a novel care program. Hemodial Int 2022; 26:308-313. [PMID: 35499673 DOI: 10.1111/hdi.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter-related bloodstream infection (CRBSI) due to dialysis is the major factor causing morbidity and mortality factor for patients undergoing hemodialysis and is associated with additional costs for these patients. This study investigated the effect of a novel care program in terms of reducing CRBSIs for hemodialysis patients with nontunneled (temporary) catheters inserted in their femoral veins. METHODS This study included dialysis patients (inpatients and outpatients) from July 2018 to September 2019, covering two periods, pre-intervention (baseline period) and intervention with a novel care program (novel care period). The novel care program was initiated on December 1, 2018. The CRBSI rates (/1000 catheter-days) for the baseline and novel care periods were compared, and the characteristics of the pathogens were determined. FINDINGS Of a total of 72 patients, 33 were from the baseline period and 39 were from the novel care period. Patients in the baseline and novel care periods had the catheter inserted in their femoral veins for a median of 20 and 29 days, respectively. The CRBSI rate decreased by 82.63%, from 8.52/1000 catheter-days in the baseline period to 1.48/1000 catheter-days in the novel care period (p = 0.036). The most common organisms involved in CRBSIs were coagulase-negative staphylococcus and Burkholderia cepacia (26% for both). DISCUSSION The novel care program reduced the incidence of CRBSIs in patients with temporary catheters inserted in their femoral veins.
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Affiliation(s)
- Kai-Ni Lee
- Graduate Institute of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chien-An Chen
- Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan.,Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Hui Wu
- Department of Nursing, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Li-Yu Yang
- Graduate Institute of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kang H, Park ST. Resolved Cerebral Venous Hypertension after Angioplasty of Central Venous Stenosis in a Hemodialysis Patient: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:206-211. [PMID: 36237346 PMCID: PMC9238213 DOI: 10.3348/jksr.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/15/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022]
Abstract
Stenosis of the central veins is a common complication in hemodialysis patients. However, cerebral venous hypertension and neurological symptoms caused by central vein stenosis are relatively rare. We present a rare case of cerebral venous hypertension in a 63-year-old male who showed venous reflux into the dural sinuses due to central venous stenosis on time-of-flight MR angiography. After management for central venous stenosis, the venous reflux disappeared.
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Affiliation(s)
- Heemin Kang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Tae Park
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Dabas A, Katiyar A, Srivastava S, Chadha A, Janardhanapillai R, Bhat K, Chadha D. A single-center 5-year experience of iatrogenic vascular injuries and their outcomes. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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.
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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
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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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Woerner A, Shin DS, Vaidya SS, Jones ST, Meissner MH, Monroe EJ, Hage AN, Chick JFB. Percutaneous Extra-Anatomic Double-Barrel Bypass for Salvage of Hemodialysis Access and Treatment of Venous Occlusive Disease. Cardiovasc Intervent Radiol 2020; 43:1942-1945. [PMID: 32808202 DOI: 10.1007/s00270-020-02615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
A woman with an upper extremity brachioaxillary arteriovenous dialysis graft presented with a 9-month history of profound ipsilateral arm swelling and numbness secondary to chronic axillosubclavian vein occlusion. Previous endovascular and open venous recanalization attempts were unsuccessful. A totally percutaneous extra-anatomic venous bi-bypass was created to salvage the dialysis access circuit and reconstruct the deep venous system. Using overlapping Viabahn stent-grafts, two parallel bypasses were created from the arteriovenous graft and brachial vein, respectively, to the brachiocephalic vein. The hemodialysis graft regained function. Upper extremity symptoms resolved within 48 h. This is the first reported percutaneous double-barrel technique of extra-anatomic venous bypass creation for simultaneous management of a failed dialysis access and chronic venous occlusive disease.
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Affiliation(s)
- Andrew Woerner
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - David S Shin
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Sandeep S Vaidya
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Sean T Jones
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Mark H Meissner
- Division of Vascular Surgery, Department of Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Anthony N Hage
- Division of Interventional Radiology, Department of Radiology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
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Endovascular treatment of cervical myelopathy from brachiocephalic venous stenosis. Radiol Case Rep 2020; 15:871-874. [PMID: 32382370 PMCID: PMC7200621 DOI: 10.1016/j.radcr.2020.04.041] [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: 03/22/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/21/2022] Open
Abstract
Central venous stenosis is a rare cause of neurologic pathology. Here we present a case of brachiocephalic vein stenosis causing cervical myelopathy through venous engorgement. Our patient was a 51-y/o male who presented with ambulatory dysfunction so he was evaluated for cervical myelopathy. Imaging revealed cord compression from venous engorgement and brachiocephalic vein stenosis. He was treated with angioplasty and vessel stenting which significantly improved flow on postintervention imaging. In conclusion, preoperative vascular imaging should be considered in myelopathic patients as it can detect this rare but dangerous etiology.
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