Hemodialysis Shunts-related Subclavian Vein Stenosis: Treatment with Self-expandable Metallic Stent

PURPOSE: To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-relatedsubclavian vein stenosis. MATERIALS AND METHODS: Self-expandable metallic stent was placed in nine patients withhemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stentplacement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis afterangioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and themeasurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. RESULTS: The stenoticsites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomicnarrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%; a resultingcomplication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this wasremoved by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosisdeveloped in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases weretreated by balloon dilatation. CONCLUSION: In hemodialytic shunt-related subclavian vein stenosis, treatmentinvolving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has notresponded to angioplasty with a high patency rate.

Transcatheter Embolization in Patients with Massive Upper Gastrointestinal Hemorrhage

Angiography and transcatheter embolization were performed in 12 patients with massive UGI bleeding from March 1990 to Feburuary 1996. These patients were all men of a mean age of 46 years (range, 33~76 years). Causes of bleeding were duodenal ulcer(5 cases), pseudoaneurysm(3 cases) due to chronic pancreatitis, hemobilia(2 cases) due to trauma, gastric mucosal injury(1 case) due to drug ingestion. Celiac arteriography and superior mesenteric arteriography were performed. Embolization was done in 12 patients. Embolic agents were steel coils. Eleven patients show an extravasaton of contrast media on angiography. In one patient who shows no extravasation, an pseudoaneurysm in gastroduodenal artery was found. Sources of bleeding were gastroduodenal artery(8), right hepatic artery(2), left hepatic artery(1), and left gastric artery(1). Bleeding was successfully controlled in all 12 patients. Two patients, however, rebled and an operation was performed. In one patient with pseudoaneurysm, bleeding recurred 13 days after embolization. This patient underwent second embolotherapy and operation 14 days later. There were no complication related to the procedure. Angiographic localization and transcatheter embolization can be an safe and effective treatment for massive UGI hemorrhage, especially in patients considered poor candidate for operation.