Acute pericardial tamponade following superior vena cava stent migration in a dialysis patient: A case report / 中国胸心血管外科临床杂志

@#Central venous stenosis is a common complication following long-term dialysis catheter placement in dialysis patients. Generally, percutaneous angioplasty is the treatment of choice, and venous stent implantation should be considered in different situations. However, the venous stent migrating into right atrium is a rare but fatal complication. We presented a patient whose superior vena cava stents migrated into right atrium, resulting in acute tamponade, and exploratory thoracotomy was proceeded.

Therapeutic effect of intervention therapy for central venous stenosis in maintenance hemodialysis patients / 第二军医大学学报

Objective To explore the efficacy of interventional therapy for central venous stenosis in maintenance hemodialysis patients. Methods The general clinical data of the maintenance hemodialysis patients with central venous stenosis, who received interventional therapy in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018, were retrospectively analyzed, and the patency of vascular access of interventional therapy were followed up. Results A total of 82 maintenance hemodialysis patients with central venous stenosis were enrolled. Six-eight patients (82.93%) had a history of temporary central venous catheterization. Among the 82 patients, 13 (15.85%) had double lesions of central vein and 69 (84.15%) had single lesion; and 5 (6.10%) had mild lesions, 17 (20.73%) had moderate lesions, 35 (42.68%) had severe lesions and 25 (30.49%) had complete occlusion. Of the 82 patients, 57 were treated by percutaneous transluminal angioplasty and 9 by percutaneous transluminal stenting. The follow-up period ranged from 12 to 62 months after operation. The patency rate of vascular access was 75.76% (50/66) at 6 months postoperatively and 68.18% (45/66) at 12 months postoperatively. The overall patency rate of vascular access was 59.09% (39/66). Conclusion Central venous stenosis of the maintenance hemodialysis patients can affect the life of vascular access. For the patients with symptoms that can not be alleviated, active intervention is recommended. Intervention therapy is safe and effective for the patients with central venous stenosis. Meanwhile, the central venous catheterization shall be avoided if possible to reduce central venous stenosis in the patients with chronic kidney disease.

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures / Utilidade da Venografia Pré-Operatória em Procedimentos de Troca de Cabos-Eletrodos ou Mudança do Modo de Estimulação

Abstract Background: Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives: We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods: From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results: Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions: The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

Resumo Fundamento: Obstruções venosas são frequentes em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) endocárdicos, mas raramente causam problemas clínicos imediatos. A principal consequência destas lesões é a dificuldade para obtenção de via de acesso para o implante de novos cabos-eletrodos. Objetivos: Determinar a prevalência de lesões venosas em candidatos a reoperações envolvendo o manuseio de cabos-eletrodos, e definir o papel da venografia pré-operatória no planejamento desses procedimentos. Métodos: De abril de 2013 a julho de 2016, 100 pacientes com indicação de troca de cabos-eletrodos, ou mudança no modo de estimulação, realizaram venografia com subtração digital no período pré-operatório. As lesões venosas foram classificadas em: não significativas (< 50%), moderadas (51-70%), graves (71-99%) ou oclusivas (100%), e a circulação colateral, em ausente, discreta, moderada ou acentuada. A estratégia cirúrgica foi definida a partir do resultado deste exame. Empregou-se análise univariada para a pesquisa de fatores de risco relacionados à ocorrência dessas lesões, com nível de significância de 5%. Resultados: Obstruções venosas moderadas foram observadas em 23%, graves em 13% e oclusões em 11% dos pacientes estudados, não sendo identificadas diferenças significativas em sua distribuição em relação ao lado do implante, ou do segmento venoso. A utilidade do exame para definição da tática operatória foi comprovada, sendo que em 99% dos casos, a estratégia cirúrgica estabelecida pode ser executada. Conclusões: A prevalência de obstruções venosas é elevada em portadores de DCEI que serão submetidos a reoperações. A venografia é altamente indicada como exame pré-operatório para o adequado planejamento cirúrgico de procedimentos envolvendo cabos-eletrodos transvenosos previamente implantados.

Síndrome de la bolsa de orina púrpura. Un caso / Purple urine bag syndrome. A case

El síndrome de la bolsa de orina púrpura es una condición muy poco frecuente, caracterizada por una llamativa coloración púrpura intensa de la orina. Se observa en pacientes con cateterización de la vía urinaria y la infección por determinadas bacterias capaces de generar una reacción química entre la orina y el material plástico de la bolsa colectora, que resulta en un llamativo color púrpura en la orina. Presentamos un caso de PUBS por ser un fenómeno poco frecuente, por la preocupación que genera en el enfermo y en el equipo de salud, y por las implicancias clínicas del manejo de las infecciones del tracto urinario

Purple urine bag syndrome is a rare condition, characterized by purple coloration of the urine inside the bag. It is observed in patients who have urinary catheters together with an infection associated with certain bacterial species, which produce a chemical reaction between the plastic of the urine bag and the urine, resulting in an intense purple color of the urine. We report a patient with PUBS, because it is an unfrequented phenomenon that generates alarm in family members and health care workers and because of the clinical implications of urinary tract infection management

The diagnostic value of enhanced MR subtracted venography in iliac vein stenosis / 实用放射学杂志

Objective To investigate the diagnostic value of enhanced MR subtracted venography (MRsV)in iliac vein stenosis. Methods 21 patients were recruited for unilateral venous circulation disorders,and they were all performed two kinds of MR venography,including time of flight (TOF)and MRsV.All raw data were reconstructed and maximum intensity proj ection (MIP)images were gained after post-processing in workstation.The image quality and diagnostic accuracy were evaluated by two experienced radiologists.All the results were analyzed,with P<0.05.Results 18 patients were enrolled in our study with good image quality,including 10 cases of unilateral iliac venous thrombosis,1 case of iliac venous stenosis infiltrated by tumor recurrence,3 cases of IVCS and 4 cases without iliac venous thrombosis.The sensitivity and specificity of MRsV-MIP were higher than TOF-MIP (100% vs 92.3%,100% vs 75%,respectively). There was significant difference in diagnostic accuracy between MRsV-MIP and TOF-MIP(χ2=4.827 2,P=0.028 0).Conclusion MRsV demonstrates better image quality and diagnostic performance than TOF in evaluation of iliac vein stenosis.MRsV has greater potential in providing the differential diagnosis evidence in venous stenosis.It could be established as an independent iliac venous imaging method.

Dialysis Catheter-Related Superior Vena Cava Syndrome with Patent Vena Cava: Long Term Efficacy of Unilateral Viatorr Stent-Graft Avoiding Catheter Manipulation

Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

Stenting of the Superior Vena Cava and Left Brachiocephalic Vein with Preserving the Central Venous Catheter in Situ

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.

The Effect of Percutaneous Angioplasty on the Treatment of Stenosis and Obstruction of Arteriovenous Fistula in the Hemodialysis Patients / 대한신장학회잡지

Providing satisfactory vascular access for hemodialysis remains one of the most challenging problems confronting nephrologists. We evaluated the effect of percutaneous angioplasty on the treatment of stenosis and obstruction of arteriovenous fistula (AVF) in the chronic hemodialysis patients. Twenty-six dilatations of stenotic or occluded lesions in hemodialysis access fistulas were performed. The type of AVF was an native AVF in 19 cases and a graft in 7 cases. The lesions involved fore arm vein in 16 cases and an upper arm veins in 10 cases. Indications for angioplasty included acute obstruction of blood flow(9 patients), increased venous dialysis(VDP) or urea recirculation ratio(URR)(8 patients), arm edema or difficulty in needle placement(6 patients), poor maturation before first needling(3 patients). The PTA initially succeeded in 23 of 26 cases(88.5%) and 3 month patency rate was 80.5%. In 8 patients with increased VDP or URR, both VDP and URR significantly decreased after PTA (VDP;118.1+/-20.7mmHg vs 89.5+/-23.8 mmHg, P= 0.04, URR;23.9+/-18.4% vs 7.5+/-6.1%, P=0.02). The complications of PTA were vessel rupture(1 patient) and hematoma(2 patients). In conclusion, PTA seems to be effective therapy in the treatment of stenosis and obstruction of arteriovenous fistula(AVF) without serious complications in the chronic hemodialysis patients.

Total Anomalous Pulmonary Venous Connection: The Results of 23 Consecutive Patients

PURPOSE: Surgical risk of total anomalous pulmonary venous connection (TAPVC) is high, especially in patients with early presentation resulting from pulmonary venous obstruction or with advanced pulmonary vascular obstructive disease (PVOD). We reviewed our experience of primary correction of TAPVC and examined the surgical outcome and risk factors. METHODS: From June 1991 to Sept. 1996, 23 neonates or infants who were diagnosed simple TAPVC and underwent primary correction at Asan Medical Center were included. They were 16 males and 7 females. We analyzed clinical records, operative records, preoperative and postoperative echocardiographic findings or cardiac catheterization angiographic data and follow-up data and analyzed risk factors for late death. RESULTS: Age at operation ranged from 1 week to 9 months (mean 66 days). 11 cases (49%) were less than 1 month and 19 cases (83%) were less than 3 months. Weight at operation ranged from 2.2kg to 6.4kg (mean 4.0 +/- 1.3kg). The anatomical types of TAPVC was supracardiac in 17, infracardiac in 4, cardiac in 1, mixed type in 1. There were 10 preoperative pulmonary venous obstructions. There were 2 cases of hospital death; one died of persistent low cardiac output from postoperative complete AV block, the other died unsuspectedly. Late death were 5 cases (23.8%). Anastomotic stenosis was suspected in 4 cases on postoperative echocardiography (1 case was confirmed by cardiac catheterization and angiography). one case died of progressive PVOD. Risk factor analysis revealed that only anastomotic stenosis was related to late death (P=0.005). CONCLUSION: From our series, we concluded that earlier surgical intervention is important to prevent PVOD especially in cases with pulmonary hypertension preoperatively and we are alert to the development of late pulmonary venous stenosis especially in cases with intimal irregularity at operative field or vague symptoms postoperatively. Finally prompt reintervention is necessary in cases with correctable pulmonary venous stenosis to decrease late death.