RESUMO
Objective: Currently, percutaneous endovascular creation of arteriovenous fistula (AVF) shows excellent outcomes. However, few systematic research evidence to support clinical decision making on the benefit of endovascular AVF is available. The purpose of this study was to evaluate the efficacy and safety of endovascular AVF (endoAVF) in patients with renal failure. Methods: We searched the Medline, Embase, Cochrane Library, and ClinicalTrials.gov databases for studies on endovascular or endovascular versus surgery for the creation of AVF. Two reviewers independently selected studies and extracted data. A systematic review and meta-analysis were performed by Review Manager 5.4 software (Revman, The Cochrane Collaboration, Oxford, United Kingdom) and Stata 15.0 (Stata Corp, College Station, TX, United States). Results: A total of 14 case series and 5 cohort studies, with 1,929 patients, were included in this study. The technique success was 98.00% for endoAVF (95% CI, 0.97-0.99; I 2 = 16.25%). There was no statistically significant difference in 3 cohort studies between endovascular and surgical AVF for procedural success (OR = 0.69; 95% CI, 0.04-11.98; P = 0.80; I 2 = 53%). The maturation rates of endoAVF were 87.00% (95% CI, 0.79-0.93; I 2 = 83.96%), and no significant difference was observed in 3 cohort studies between the 2 groups (OR = 0.73; 95% CI, 0.20-2.63; P = 0.63; I 2 = 88%). Procedure-related complications for endoAVF was 7% (95% CI, 0.04-0.17; I 2 = 78.31%), and it did not show significant difference in 4 cohort studies between the 2 groups (OR = 1.85; 95% CI, 0.37-9.16; P = 0.45; I 2 = 59%). Conclusion: The endovascular creation of AVF is potentially effective and safe. These important data may provide evidence to support clinicians and patients in making decisions with endovascular AVF. But further research is great necessary due to lack of randomized controlled studies.
RESUMO
Background: Central vein occlusion (CVO) is a serious problem in hemodialysis patients. There is an unsatisfactory result for refractory CVO by sharp recanalization alone. This study evaluated the efficacy and safety of blunt impingement followed by sharp recanalization for the treatment of CVO in hemodialysis patients. Methods: This study retrospectively examined hemodialysis patients with CVO who failed to recanalize using standard guidewire and catheter techniques in our department. In the first instance, all CVOs were recanalized using blunt impingement techniques, including a 6-Fr long sheath (Cook Incorporated, Bloomington, IN USA) and an 8-Fr sheath of Rosch-Uchida Transjugular Liver Access Set (RUPS-100; Cook Incorporated, Bloomington, IN, USA). If this was not successful, sharp recanalization devices were applied, including the stiff tip of a guidewire (Terumo, Tokyo, Japan), the RUPS-100, and the percutaneous transhepatic cholangial drainage (PTCD) needle (Cook Incorporated, USA). All patients were followed up at least 4 months postoperatively. The technical success rate, arteriovenous access patency rates, and operation-related complications were analyzed. Results: The procedural success rate was 100.0% (30 of 30). Thirty patients with CVO underwent blunt impingement with a technique success rate of 70.0% (21 of 30), and 9 patients received sharp recanalization after failed blunt impingement, with a technique success rate of 100.0% (9 of 9). The primary patency rates at 6 and 12 months postoperatively were 86.7% and 53.3%, respectively. The primary assisted patency rates were 93.3% and 63.3%, and the secondary patency rates were 93.3% and 70.0% at 6 and 12 months, respectively. One major procedure-related complication was detected, namely, a small injury of the superior vena cava (SVC) wall in a patient receiving recanalization via the stiff end of a guidewire, but this did not require further treatment. Conclusions: It is potentially effective and safe for interventionalists to use blunt impingement followed by sharp recanalization techniques to treat chronic CVO that is refractory to traversal using traditional catheter and guidewire techniques.
RESUMO
BACKGROUND: Multiple complete central venous occlusion (CVO) is rare complication among the hemodialysis population. Percutaneous transluminal angioplasty (PTA) is the recommended treatment for CVO; however, cases with long-segment occlusion remain challenging. CASE DESCRIPTION: We reported a patient who complained of a swollen right arm for 1 month. On admission, his vital signs were within normal limits. The 76-year-old man had been on hemodialysis with a right forearm arteriovenous fistula (AVF) for 4 years with a history of temporizing catheterization and left forearm AVF failure. One year ago, he gradually developed a slight swelling in his right arm and the swelling in his arm was significantly worse one month ago. Digital subtraction angiography (DSA) revealed occlusion in his right innominate vein (IV), proximal subclavian vein (SV), and external and internal jugular veins, as well as stenosis of the ipsilateral cephalic arch and axillary vein (AV). The operation was performed with a pioneered bidirectional approach via ipsilateral superior vena cava (SVC) and AV puncture. The occluded lesions were successfully recanalized, and the patient's symptoms resolved after the operation. The patency of his vascular access was well maintained at the 4-month follow-up. CONCLUSIONS: To the best of our knowledge, this is the first report regarding the application of SVC puncture in PTA for CVO. This technique could be a possible approach when performed by appropriately qualified operators in patients with limited or no other options.
