Treatment options for hemodialysis-related central vein occlusive disease: Case series and review of literature

@#Central venous occlusive disease is commonly seen in patients undergoing hemodialysis and can threaten the viability of the arteriovenous access. Majority of cases are related to central venous catheter placement. This paper reports on three patients on chronic hemodialysis who presented with signs and symptoms of upper extremity venous hypertension and underwent three different therapeutic modalities, all with successful relief of symptoms. A review of the existing literature on past and current treatment options is done.

Do the Different Types of Pulmonary Hypertension Cause the Same Effect on Right Heart and Serum Asymmetrical Dimethylarginine Levels in Female Patients?

ABSTRACT Objective: Right-heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. This study aimed to evaluate if different types of pulmonary hypertension (PH) would cause the same effect on right-heart functions and serum ADMA levels in female patients. Methods: This study included patients with PAH as group I, patients with PVH due to mitral stenosis (mitral valve area ≤ 1.5 cm2, without any additional valve or left-heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II, and healthy control subjects as group III. Transthorasic echocardiographic evaluations for right-heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected, and the serum ADMA concentrations were obtained with the ELISA kit (DRG® International Inc., Springfield, NJ, USA). Results: Patients in groups I and II had higher ADMA levels than healthy control subjects. Right-atrium area and dimensions, right-ventricular (RV) volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure, RV wall thickness, and RV outflow tract diameters were significantly higher in group I patients than in group II patients. Right-ventricular myocardial performance index was lower, and RV fractional area change and tricuspid valve systolic tissue Doppler velocity were higher in group II patients than in group I patients. Conclusion: This study demonstrated that both PAH and PVH caused increase in right-heart dimensions and impairment in right-heart functions.

Tratamiento exitoso de lipodermatoesclerosis aguda con doxiciclina: reporte de diez casos / Successful treatment of acute lipodermatosclerosis with doxycycline: report of ten cases

Resumen La doxiciclina, una tetraciclina semisintética de segunda generación, ampliamente usada para el tratamiento de patologías dermatológicas por sus propiedades antimicrobianas, ha demostrado en varios estudios experimentales sus acciones como un potente fármaco antiinflamatorio, aprobado por estas características por la FDA como una terapia complementaria en la periodontitis del adulto, así como en el tratamiento de la forma papulopustulosa de la rosácea. Se describen además en la literatura otras indicaciones para procesos inflamatorios, tales como, calcinosis cutis, vasculitis livedoide, patologías ampollares, entre otras. Se presenta una serie de 10 pacientes con lipodermatoesclerosis que presentaron una respuesta eficaz a su patología al recibir tratamiento con doxiciclina durante 3 meses, destacando de esta forma su eficacia terapéutica, accesibilidad y baja asociación a efectos adversos.

Abstract Doxycycline, a second generation semi-synthetic tetracycline, widely used for the treatment of dermatological diseases for its antimicrobial effects, has shown in many clinical studies its actions as a powerful anti-inflammatory drug. Approved by the FDA as a complementary therapy in adult periodontitis, and of the papulopustular form of rosacea. In addition, other indications for inflammatory processes are described in the literature, such as calcinosis cutis, livedoid vasculitis, blistering pathologies, among others. We present a series of 10 patients with lipodermatosclerosis who presented an effective response to their pathology when receiving treatment with doxycycline for 3 months. Its therapeutic efficacy, accessibility and low association with adverse effects are highlighted.

Endovascular treatment of occlusive central venous disease: one center's experience / Tratamento endovascular da doença venosa oclusiva central: experiência de um centro

INTRODUCTION: The majority of cases of stenosis or occlusion of central veins are the result of central catheters, arteriovenous fistulas, neoplasms or traumas and these conditions can cause severe cases of venous hypertension or reduce the flow through fistulas. The objective of this study is to analyze the results of central venous angioplasties conducted at our hospital. METHODOLOGY: We conducted a retrospective and descriptive study to analyze the results of central venous angioplasties conducted from 2010 to 2012 at a university hospital run by the Universidade Estadual de Londrina, Brazil. We calculated primary and secondary success rates and analyzed whether or not stents were used and complications occurred during a 6-month follow-up period. RESULTS: A total of 25 central venous angioplasties were conducted. Twenty-four (96%) of these were because of catheter-related intimal hyperplasia and one was to treat the effects of compression by a tumor. Fifteen (60%) angioplasties were to correct stenosis and ten (40%) were because of occlusions, with a one-hundred percent success rate for all stenosis-related procedures. However, none of the cases of occlusion could be treated endovascularly. Patency during the 6-months follow-up period was 80% after reinterventions. CONCLUSIONS: Despite good results observed after primary interventions for stenoses, it must be accepted that all current treatment options for chronic occlusive venous disease will, sooner or later, lead to restenosis or occlusion. Venous occlusions constitute a challenge demanding the development of new techniques and new materials. Prevention is paramount, through avoidance of central catheterization and early creation of arteriovenous fistulas...

INTRODUÇÃO: A estenose ou a oclusão de veias centrais ocorre, na maioria das vezes, em consequência de catéteres centrais, fístulas arteriovenosas, neoplasias e traumas, podendo levar a quadros severos de hipertensão venosa e de redução do débito dessas fístulas. O presente trabalho tem como objetivo analisar os resultados obtidos nas angioplastias venosas centrais em nosso hospital. METODOLOGIA: Realizamos um estudo retrospectivo, descritivo, analisando os resultados obtidos nas angioplastias venosas centrais realizadas no Hospital Universitário da Universidade Estadual de Londrina durante os anos de 2010 a 2012. Verificamos as taxas de sucesso primário e secundário, a utilização ou não de stents e as complicações, analisadas durante um período de acompanhamento de seis meses. RESULTADOS: Foram realizadas 25 angioplastias venosas centrais, sendo 24 (96%) por hiperplasia intimal relacionada ao uso de catéteres e uma por compressão tumoral. Destas, 15 (60%) eram estenoses e dez (40%) eram oclusões, obtendo-se sucesso primário técnico em todos os procedimentos relacionados à estenose. Contudo, nenhum caso de oclusão pode ser tratado por via endovascular. No acompanhamento de seis meses, após reintervenções, observamos perviedade de 80%. CONCLUSÃO: Apesar dos bons resultados observados nas intervenções primárias sobre as estenoses, indiscutivelmente todas as opções atuais para o tratamento da doença venosa oclusiva crônica irão levar, precoce ou tardiamente, à reestenose ou à oclusão. As oclusões venosas constituem uma incitação para o desenvolvimento de novas técnicas e novos materiais. A prevenção assume papel preponderante, com redução da implantação de catéteres...

A Case Report of a Successful Bypass Operation for Peripheral Venous Hypertension with Digital Pigmentation and Ulcer with Crust in Hemodialysis Patient / 대한혈관외과학회지

Peripheral venous hypertension is a rare complication in end-stage renal disease patients undergoing maintenance hemodialysis. Primarily, it is secondary to frequent venous accesses, thrombosis, and to other causes. Venous hypertension may cause pain and edema of the ipsilateral arm; increased venous pressure can prevent acceptable flow rates during dialysis. In this case report, we describe our experience using a Gore-Tex tube graft to treat a venous bypass complicated by peripheral venous hypertension with digital pigmentation and an ulcer with crust. Based on our experience, this technique is as an effective and low-risk surgical option to treat this condition.

Role of Leukocyte Activation and Inflammatory Reaction in Chronic Venous Insufficiency / 中国普外基础与临床杂志

Objective To discuss the role of leukocyte activation and inflammatory processes in the disease of chronic venous insufficiency(CVI).Methods The relevant literatures about the role of leukocyte activation and in- flammatory reaction in CVI were reviewed.Results The role of inflammatory reaction in occurrence and develop- ment of venous diseases has been studied a lot in recent years.It was found that the leukocyte activation and inflam- matory reaction are involved in the structural remodeling of venous valves and walls,leading to valvular incompe- tence and formation of varicose veins.Conclusion Leukocyte activation and inflammatory processes take important roles in the occurrence and progression of CVI.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

A Case of Occipital Dural Arteriovenous Malformation Presenting Visual Field Defect and Positive Visual Phenomena

Although dural arteriovenous malformations(DAVM) involving the occipital lobe can be the cause of variable posi-tive visual phenomena, the mechanism of these visual disturbances is not fully understood. We report a 42-year-old man with a left occipital DAVM presenting headache and positive visual phenomena in the right hemianopic field. Occipital DAVM was not accompanied by parenchymal lesions in a brain magnetic resonance imaging. The cerebral angiography demonstrated the retrograde flow into the dilated occipital cortical veins as well as the left occipital DAVM having multiple arterial feeders and the drainage into the left transverse sinus. All clinical symptoms disap-peared after a transarterial embolization. Brain 99mTc-ECD single photon emission computed tomography also showed the improvement of hypoperfusion on the left occipital area after the embolization. We believe that the venous hyper-tension by occipital DAVM impeding the perfusion to the occipital lobe plays an important role in producing positive visual phenomena on the hemianopic field.

A Surgical Experience of Venous Hypertension Induced by Long Term Postthrombectomy Arteriovenous Fistula: Case report

Venous thrombectomy and temporary arteriovenous (AV) fistula are performed for the treatment of iliofemoral venous thrombosis. The theory behind creation of an AV fistula is to increase venous flow, thereby maintaining patency. But AV fistula might induce severe peripheral venous hypertension in the condition of proximal venous segment reocclusion. A 62-year-old woman who developed severe peripheral venous hypertension after postthrombectomy AV fistula visited our clinic. We treated this patient with simple ligation of the AV fistula.

Venous Hypertension after Internal Arteriovenous Anastomosis on the Forearm for Hemodialysis: Report of 2 Cases / 대한비뇨기과학회지

Venous hypertension is caused by the inflow of the arterial blood to the dis-tal venous system due to an obstruction or stenosis of the proximal venous branch in the Patients with internal arteriovenous shunt for hemodialysis. We report the two cases of venous hypertension in patients with internal shunt between the radial artery and the cephalic vein for the first time in Korea. Clinical manifestations were severe pain, swelling, tenderness, hyperpigmentation and ulceration on the involved hand and/or fingers. Venogram showed an obstruction or stenosis of the cephalic vein proximal to the shunt and congestion in the cephalic vein distally. There was no obstruction or stenosis of the ipsilateral subclavian vein. We corrected venous hypert6nsion by ligation of the cephalic vein distal to the shunt and end to end anastomosis between the distal cephalic vein and the basilic vein with interposition of the artificial vessel(Gore-tex(R)). In the follow-up, skin lesions and edema were completely resolved by the second week postoperatively.

Intracerebral Hemorrhage from a Traumatic Carotid Cavernous Fistula: Case Report

No abstract available.