Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. Aim The present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. Methods A database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. Results The study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. Conclusions Endovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Percutaneous transluminal angioplasty for the treatment of swollen hand syndrome in hemodialysis patients / 介入放射学杂志

Objective To evaluate the success rate,vascular patency time and their influencing factors of percutaneous transluminal angioplasty (PTA) in treating swollen hand syndrome in hemodialysis patients.Methods The clinical data of 16 hemodialysis patients with swollen hand syndrome,who were admitted to authors' hospital during the period from May 2015 to March 2017 to receive PTA,were retrospectively analyzed.The technical success rate,the follow-up primary vascular patency time and primary patency rate were calculated,and the factors influencing technical success rate and vascular patency time were analyzed.Results Venography with DSA revealed that a total of 16 segments of venous stenosis or occlusion were found in 16 patients,including 6 stenotic lesions and 10 occlusive lesions.Successful PTA was obtained in 14 patients,including one patient whose angiography performed immediately after PTA with balloon dilatation showed that the stenosis was still over 50％,and stent implantation had to be carried out.The technical success rate was 87.5％,in 2 patients PTA failed as the guide wire could not pass through the long segment of vascular occlusion.The 14 patients were followed up for 3-24 months,and the median patency time was 10.5 months.The 3-,6-and 12-month primary patency rates were 71.4％ (10/14),57.1％ (8/14) and 42.9％ (6/14) respectively.Univariate analysis indicated that the length of occlusive segment and the balloon pressure required for angioplasty were the potential factors that affected the postoperative vascular patency time.Conclusion For the treatment of swollen hand syndrome in hemodialysis patients,PTA is safe and effective,although long-term vascular patency rate needs to be further improved.

Endovascular interventions for central vein stenosis

Central vein stenosis is common because of the placement of venous access and cardiac intravascular devices and compromises vascular access for dialysis. Endovascular intervention with angioplasty and/or stent placement is the preferred approach, but the results are suboptimal and limited. Primary patency after angioplasty alone is poor, but secondary patency can be maintained with repeated angioplasty. Stent placement is recommended for quick recurrence or elastic recoil of stenosis. Primary patency of stents is also poor, though covered stents have recently shown better patency than bare metal stents. Secondary patency requires repeated intervention. Recanalization of occluded central veins is tedious and not always successful. Placement of hybrid graft-catheter with a combined endovascular surgical approach can maintain patency in many cases. In the presence of debilitating symptoms, palliative approach with endovascular banding or occlusion of the access may be necessary. Prevention of central vein stenosis is the most desirable strategy.

Veno-veno Bypass for Central Vein Occlusion in Hemodialysis Patients: Two cases report

Central venous stenosis or occlusion is a serious complication in end-stage renal disease patients undergoing maintenance hemodialysis. It is mostly secondary to trauma caused by temporary or permanent hemodialysis catheter placement. Venous hypertension may cause pain, edema of the ipsilateral arm and increased venous pressure prevents acceptable flow rates during dialysis. Venous bypass to the internal jugular vein, the external jugular vein, or axillary vein to saphenous vein bypass have been described as alternative options of surgical management. Our patients underwent internal jugular vein bypass. We think it is an effective and low risk surgical option.

Central Vein Stenosis in Hemodialysis Patients

PURPOSE: Central vein stenosis (CVS) is a common problem for the patients on chronic hemodialysis. It is primarily a result of previous catheterization of a central vein. This study investigated the characteristics of this problem and the effect following treatment different modalities. METHOD: We reviewed the medical records of 23 dialysis patients who had diagnosed with central venous stenosis from January 2001 to March 2005. We reviewed the characteristics, clinical manifestations and effects of treatment. RESULT: Of the total 23 patients, 9 patients had no past history of central vein catheterization ipsilateral to the vascular access. The most common site of venous lesion was the left innominate vein (n=12). A total of 20 patients underwent treatment. Of these 20 patients, 14 (20%) underwent balloon angioplasty, 5 underwent percutaneous transluminal angioplasty (PTA) with stent insertion and 1 underwent bypass surgery. The primary patency rate was 57% for the balloon angioplasty and 40% for the PTA with stent insertion. The numbers of patients in need of repeat treatment following the initial endovascular treatment were 2 of 14 patients (14%) for balloon angioplasty and 2 of 5 (40%) for the PTA with stenting. CONCLUSION: The primary goal of diagnosis and therapy for CVS is to maintaining the functionality of the access and to relieve the symptoms. Radiogical intervention is a gold standard. The long term patency after angioplasty, with or without stents, remains unproven.

A Case of Superior Vena Cava Syndrome Due to Catheterization of the Internal Jugular Vein for Hemodialysis / 대한신장학회잡지

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.

A Case of Superior Vena Cava Syndrome Due to Catheterization of the Internal Jugular Vein for Hemodialysis / 대한신장학회잡지

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. However, the exponential increase in use of indwelling central venous catheters and cardiac pacemakers over the last two decades has resulted in more patients with SVC syndrome. Internal jugular vein cannulation has become the preferred approach for temporary hemodialysis catheter placement following the reports of an increased incidence of subclavian vein stenosis due to subclavian vein catheterization. We describe a patient who developed SVC syndrome after internal jugular vein catheterization. The patient had been swollen the left arm intermittently due to left central vein stenosis for 1 year and experienced balloon angioplasty and stent insertion for three times. We diagnosed the SVC syndrome through the both subclavian venography, which revealed complete obstruction of the left brachiocephalic vein with extensive collateral circulation and mild stenosis of the distal right internal jugular vein. Resolution of the clinical SVC sydrome occurred after catheter removal.