1
|
Xu Z, He Y, Liu X. Utility of covered stents as a bypass for the treatment of central venous occlusion: a case report. BMC Nephrol 2024; 25:271. [PMID: 39182042 PMCID: PMC11344384 DOI: 10.1186/s12882-024-03718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Central venous occlusion (CVO) is difficult to treat with percutaneous transluminal angioplasty because the guidewire cannot pass through the occluded segments. In this study, we devised a new method for establishing an extra-anatomic bypass between the right subclavian vein and the superior vena cava via a covered stent to treat whole-segment occlusion of the right brachiocephalic vein (BCV) with calcification. CASE PRESENTATION We present the case of a 58-year-old female patient who complained of right arm swelling present for 1.5 years. Twelve years prior, the patient began hemodialysis because chronic glomerulonephritis had progressed to end-stage renal disease. During the first 3 years, a right internal jugular vein (IJV)-tunneled cuffed catheter was used as the dialysis access, and the catheter was replaced once. A left arteriovenous fistula (AVF) was subsequently established. Owing to occlusion of the left AVF, a new fistula was established on the right upper extremity 1.5 years prior to this visit. Angiography of the right upper extremity revealed complete occlusion of the right BCV and IJV with calcification. Because of the failure to pass the guidewire across the lesion, we established an extra-anatomic bypass between the right subclavian vein and the superior vena cava with a covered stent. Angiography confirmed the patency of whole vascular access system. After 3 months of follow-up, the patient's AVF function and the bypass patency were satisfactory. CONCLUSIONS As a new alternative for the treatment of long, angled CVO with or without calcification, a covered stent can be used to establish an extravascular bypass between central veins.
Collapse
Affiliation(s)
- Zhihui Xu
- Department of Cardiology and Nephrology, 962nd Hospital of the PLA Joint Logistics Support Force, Harbin, China
| | - Yixin He
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaomeng Liu
- Department of Dialysis, Heilongjiang Provincial Hospital, Zhongshan Road, Xiangfang District, Harbin, 150001, Heilongjiang Province, China.
| |
Collapse
|
2
|
Chen MCY, Weng MJ, Chao LH. Characterization of hemodialysis fistulas experienced abrupt thrombosis and determination of a proper follow-up protocol: A retrospective cohort study and an interventionist's perspective. PLoS One 2023; 18:e0282891. [PMID: 36913383 PMCID: PMC10010559 DOI: 10.1371/journal.pone.0282891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
Abrupt thrombosis is a form of thrombosis that occurs unexpectedly and without being preceded by hemodialysis fistula (AVF) dysfunction during dialysis. We found that AVFs with a history of abrupt thrombosis (abtAVF) appeared to have more episodes of thrombosis and required more frequent interventions than those without such history. Therefore, we sought to characterize the abtAVFs and examined our follow-up protocols to determine which one is optimal. We performed a retrospective cohort study using routinely collected data. The thrombosis rate, AVF loss rate, thrombosis-free primary patency, and secondary patency were calculated. Additionally, the restenosis rates of the AVFs under the follow-up protocol/sub-protocols and the abtAVFs were determined. The thrombosis rate, procedure rate, AVF loss rate, thrombosis-free primary patency, and secondary patency of the abtAVFs were 0.237/pt-yr, 2.702/pt-yr, 0.027/pt-yr, 78.3%, and 96.0%, respectively. The restenosis rate for AVFs in the abtAVF group and the angiographic follow-up sub-protocol were similar. However, the abtAVF group had a significantly higher thrombosis rate and AVF loss rate than AVFs without a history of abrupt thrombosis (n-abtAVF). The lowest thrombosis rate was observed for n-abtAVFs, followed up periodically under the outpatient or angiographic sub-protocols. AVFs with a history of abrupt thrombosis had a high restenosis rate, and periodic angiographic follow-up with a mean interval of 3 months was presumed appropriate. For selected populations, such as salvage-challenging AVFs, periodic outpatient or angiographic follow-up was mandatory to extend their usable lives for hemodialysis.
Collapse
Affiliation(s)
- Matt Chiung-Yu Chen
- Department of Interventional Radiology, Yuan’s General Hospital, Kaohsiung, Taiwan
- * E-mail:
| | - Mei-Jui Weng
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lee-Hua Chao
- Department of Interventional Radiology, Yuan’s General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
3
|
Noh SY, Goo DE, Kim YJ, Yang SB, Lee JM, Lee WH. Sharp Needle Recanalization Technique for Peripheral Hemodialysis Arteriovenous Fistula Occlusion. Cardiovasc Intervent Radiol 2021; 44:1809-1816. [PMID: 34258680 DOI: 10.1007/s00270-021-02809-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of a percutaneous sharp needle recanalization technique for the treatment of peripheral hemodialysis arteriovenous fistula (AVF) occlusion. MATERIALS AND METHODS This study included 13 patients (14 procedures) between May 2010 and February 2020 with non-thrombotic AVF occlusion wherein guidewire passage through the occluded segment had failed. We successfully passed the guidewire through the occluded segment using a sharp needle recanalization technique with Chiba or Colapinto needles, under ultrasound or fluoroscopic guidance. The type of AVF, site and length of occlusion, technical success, complications, and long-term patency were analyzed. RESULTS Technical success was achieved in 12 (85.7%) out of 14 procedures. The procedure failed in two patients due to the poor angle of approach in the axillary area and diffuse severe stenosis in the draining cephalic vein. In eight procedures, sharp needle recanalization was performed under ultrasound guidance, while the other six procedures were performed under fluoroscopic guidance. Chiba and Colapinto needles were used in five and nine procedures, respectively. The mean length of occlusion was 2.7 cm (range 1.8-4.2 cm). There was one case of mild complication, that is, mild contrast extravasation, which was treated by stent deployment. The post-intervention primary patency rates at 6 months, 1 year, and 2 years were 81.8%, 36.4%, and 18.2%, respectively. CONCLUSION The results of this limited series suggest that the sharp needle recanalization technique is a simple and effective method for the treatment of peripheral non-thrombotic AVF occlusion.
Collapse
Affiliation(s)
- Seung Yeon Noh
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong Erk Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea.
| | - Yong Jae Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul, 04401, Korea
| | - Seung Boo Yang
- Department of Radiology, Soon Chun Hyang University Hospital, Gumi, Korea
| | - Jae Myeong Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Woong Hee Lee
- Department of Radiology, Soon Chun Hyang University Hospital, Cheonan, Korea
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Chen MCY, Weng MJ. Percutaneous Extraanatomic Bypass for Treatment of Central Venous Occlusions in Patients Undergoing Hemodialysis. AJR Am J Roentgenol 2020; 214:477-481. [DOI: 10.2214/ajr.19.21721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Matt Chiung-Yu Chen
- Department of Interventional Radiology, Yuan's General Hospital, No. 162, Cheng-gong 1st Rd, Lingya District, Kaohsiung City 802, Taiwan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Jui Weng
- Department of Interventional Radiology, Yuan's General Hospital, No. 162, Cheng-gong 1st Rd, Lingya District, Kaohsiung City 802, Taiwan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Percutaneous Costoclavicular Bypass for Thoracic Outlet Syndrome and Cephalic Arch Occlusion in Hemodialysis Patients. J Vasc Interv Radiol 2019; 30:1779-1784. [DOI: 10.1016/j.jvir.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022] Open
|
7
|
Chen MCY, Weng MJ, Liang HL. Endovascular bypass for salvage of vascular access in hemodialysis catheter-consigned patients. J Vasc Access 2018; 19:585-592. [PMID: 29560785 DOI: 10.1177/1129729818764132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE: This study was performed to retrospectively assess the efficacy of percutaneous creation of an intervascular bypass with or without stent graft deployment (endovascular bypass) for salvage of abandoned vascular access sites in hemodialysis catheter-consigned patients. METHODS: Salvage of abandoned vascular access sites was attempted in 16 patients with hemodialysis catheters. These vascular access sites were salvaged using endovascular bypass techniques to redirect the access flow to a nonarterialized vein as a new outflow conduit or cannulation segment. The postintervention primary, assisted primary, and secondary patency rates of the access site and bypass were calculated using the Kaplan-Meier method. RESULTS: The procedural and clinical success rates were both 100%. The postintervention primary patency rate of the bypass and access site at 360 days was 75.7 ± 12.5% and 56.8 ± 14.9%, respectively. The mean follow-up period was 461.9 days (range: 121-900 days). No major complications were observed. One bare bypass tunnel rupture and one pseudoaneurysm were noted during the procedure. CONCLUSION: Salvage of abandoned vascular access sites for hemodialysis catheter-consigned patients can be technically feasible and clinically successful using endovascular bypass techniques in selected patients when surgical revision is not considered or is not possible.
Collapse
Affiliation(s)
- Matt Chiung-Yu Chen
- 1 Department of Interventional Radiology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Mei-Jui Weng
- 2 Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huei-Lung Liang
- 2 Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|