Central venous stenosis in haemodialysis patients without a previous history of catheter placement

doi:10.1016/j.ejrad.2004.11.006

European Journal of Radiology

Volume 55, Issue 2, August 2005, Pages 237-242

https://doi.org/10.1016/j.ejrad.2004.11.006 Get rights and content

Abstract

Objective:

To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement.

Material and methods:

Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32–60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient.

Results:

Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV.

Conclusion:

Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

Introduction

Central venous stenosis or occlusion is a serious complication in haemodialysis patients and is mostly secondary to trauma caused by temporary or permanent haemodialysis catheter placement. Central vein stenosis is much more common when the subclavian vein (SCV) rather than the internal jugular vein is used for catheterization and SCV catheterization should be abandoned [1]. Central vein stenosis may cause swelling of the arm, which may preclude cannulation of the arm veins during haemodialysis, and may cause increased rates of recirculation. It may also cause difficulties for the future placement of temporary or permanent central venous catheters.

Although rare, central venous stenosis or occlusion may also develop without a history of previous central venous catheter placement [1], [2]. The exact mechanism leading to stenosis in these patients is unknown and there are very few case reports in the literature. We report detailed haemodialysis history, imaging findings and outcome of endovascular treatment in six patients who developed central venous stenosis without a previous catheter placement.

Section snippets

Materials and methods

Between April 2000 and June 2004, 57 haemodialysis patients with stenosis or occlusion of a central vein ipsilateral to a functioning permanent vascular access were treated with endovascular balloon angioplasty with or without stent placement in our university hospital. The stenosis/occlusion was on the right in 27 (47%) patients, on the left in 29 (51%) patients and in the superior vena cava in one (2%) patient. Six of 57 patients (10%) with central vein stenosis ipsilateral to the functioning

Results

The degree of stenosis was 60% in one patient and greater than 70% in other five patients. Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein (Fig. 1). Lesion length ranged from 1 to 4 cm. All six patients with stenosis or occlusion of a central vein have had a functioning vascular access without acute thrombus in any of the vessels from the arteriovenous anastomosis to the superior vena cava. The duration of the vascular

Discussion

All six patients in our study group had stenosis of the central veins on the left side and all of them had a vascular access with very high flow volumes. Another common feature in five of six patients was elbow location of the vascular access with brachiocephalic AVF in four patients and brachioaxillary AVG in one patient. AVGs in general and AVFs located around elbow have higher flow volumes when compared to distal Brescia–Cimino type AVFs. The only patient with a wrist level Brescia–Cimino

Conclusion

Central venous stenosis ipsilateral to the functioning vascular access in haemodialysis patients without a history of central venous catheterization is not very infrequent. It comprised one-tenth of central venous stenosis in our patient population. The lesions tend to occur in patients with a proximal permanent vascular access like elbow AVF or AVG with very high flow rates. Endovascular treatment with balloon angioplasty with or without stent placement offers good secondary patency rates in

References (11)

V. Wong et al.
Factors associated with early failure of arteriovenous fistulae for haemodialysis access
Eur J Vasc Endovasc Surg
(1996)
M. Itkin et al.
Extrinsic compression of the left innominate vein in haemodialysis patients
J Vasc Interv Radiol
(2004)
V. Mickley et al.
Stenting of central venous stenoses in haemodialysis patients: long term results
Kidney Int
(1997)
F. Hammer et al.
Crushed stents in benign left brachiocephalic stenosis
J Vasc Surg
(2000)
F. Schillinger et al.
Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses
Nephrol Dial Transplant
(1991)

There are more references available in the full text version of this article.

Cited by (119)

Clinical Outcomes of Standardized Central Venous Catheterization Simulation Training: A Comparative Analysis
2024, Journal of Surgical Education
A standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) using online- and simulation-based training was first designed and then large-scale deployed at a teaching hospital institution to improve CVC surgical education. To understand the impact that the standardized training might have on patient complications, this study focuses on identifying the impact of the integration of an iteratively designed US-IJCVC training on clinical complications at a teaching hospital.
A comparative study was conducted using TriNetX, a global health research network. Using Current Procedural Terminology (CPT) codes and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified the total number of patients with a CVC and mechanical, infectious, and thrombosis complications with and without billable ultrasound between July 1 to June 30 in 2016, 2017, and 2022.
A teaching hospital institution in Pennsylvania.
Results showed a correlation between years and complications indicating, (1) mechanical complications _{billable ultrasound,} (2) infectious complications _{billable ultrasound,} and (3) thrombosis complications _{billable ultrasound} were significantly lower with the large-scale deployment. Results also showed that (4) mechanical, infectious, and thrombosis complications with and without billable ultrasound are within the range that prior work has reported.
These results indicate that there has been a decrease in mechanical, infectious, and thrombosis complications, which correlates with the US-IJCVC training large-scale deployment.
Efficacy and Safety of Sharp Recanalization with the Stiff End of a Microguidewire for Treatment of Refractory Central Venous Occlusions in Hemodialysis Patients
2024, Annals of Vascular Surgery
Sharp recanalization is a viable procedure for some refractory central venous occlusions that cannot be recanalized with the conventional technique. The sharp recanalization procedures reported in previous studies are often rely on costly devices and with a certain proportion of complications. This study aimed to present an inexpensive and risk-controllable coaxial centrifugally sharp recanalization technique that was independent of any additional costly devices.
This retrospective study enrolled 8 patients who had received sharp recanalization of central venous occlusions, between August 2017 and May 2021. The sharp recanalization technique was performed centrifugally with the stiff end of a microguidewire after the lesions failed to be passed through with the conventional technique. Clinical data of patients on their lesions, technical success rate, procedure-related complications, and patency rates were collected and analyzed to assess the efficacy and safety of the technique.
Technical success was achieved in all patients, with no complications were observed. All symptoms were ameliorated within 48h postsurgery. The median follow-up period was 22 months. All patients maintained patency or assisted patency at 12 month follow-up.
Sharp recanalization performed centrifugally with the stiff end of the microguidewire could be a cost-effective and safe alternative procedure for the treatment of refractory central venous occlusion that cannot be recanalized with conventional technique.
Body and Extremity MR Venography: Technique, Clinical Applications, and Advances
2023, Magnetic Resonance Imaging Clinics of North America
Acute venous problems: Integrating medical, surgical, and interventional treatments
2023, Seminars in Vascular Surgery
“Acute venous problems” refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment.
Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
Left innominate vein stenosis treated with graft replacement with concomitant cardiac surgery
2021, Journal of Vascular Surgery Cases and Innovative Techniques
Citation Excerpt :
Oguzkurt et al6 reported that 6 of 57 hemodialysis patients (10%) with central venous stenosis ipsilateral to the functioning vascular access did not have a history of previous central catheter placement. They also reported that patients with central venous stenosis had had vascular access with very high flow volumes.6 Oguzkurt et al6 reported that intravascular ultrasonography showed thickening of a venous valve at the site of the stenosis.
Left innominate vein stenosis is a serious complication that causes massive venous hypertension and vascular access failure in patients requiring hemodialysis. Percutaneous transluminal angioplasty has been the standard treatment strategy; however, the outcome has been unsatisfactory, with a low primary patency rate. We present the case of a 49-year-old man with symptomatic left innominate vein stenosis that was successfully treated with graft replacement concomitantly with aortic valve replacement via median sternotomy. During surgery, appropriate cardiopulmonary bypass circulation should be established to avoid cerebral venous hypertension, which can cause irreversible brain damage.
Reduced patency in left-sided arteriovenous grafts in a porcine model
2020, Journal of Vascular Surgery
The porcine arteriovenous graft model is commonly used to study hemodialysis vascular access failure, with most studies using a bilateral, paired-site approach in either the neck or femoral vessels. In humans, left- and right-sided central veins have different anatomy and diameters, and left-sided central vein catheters have worse outcomes. We assessed the effect of laterality on arteriovenous prosthetic graft patency and hypothesized that left-sided carotid-jugular arteriovenous prosthetic grafts have reduced patency in the porcine model.
Arteriovenous polytetrafluoroethylene grafts were placed ipsilaterally or bilaterally in 10 Yorkshire male pigs from the common carotid artery to the internal jugular vein. Ultrasound measurements of blood flow velocities and diameters were assessed before graft placement. Animals were sacrificed at 1 week, 2 weeks, or 3 weeks. Patency was determined clinically; grafts and perianastomotic vessels were excised and analyzed with histology and immunostaining.
At baseline, left- and right-sided veins and arteries had similar blood flow velocities. Although internal jugular veins had similar diameters at baseline, left-sided carotid arteries had 11% smaller outer diameters (P = .0354). There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; only 4 of 10 (40%) grafts were patent on the left compared with 7 of 8 (88%) grafts patent on the right (P = .04). Left-sided grafts had increased macrophages at the arterial anastomosis (P = .0007). Left-sided perianastomotic arteries had thicker walls (0.74 vs 0.60 mm; P = .0211) with increased intima-media area (1.14 vs 0.77 mm²; P = .0169) as well as a trend toward 38% smaller luminal diameter (1.6 vs 2.5 mm; P = .0668) and 20% smaller outer diameter (3.0 vs 3.7 mm; P = .0861). Left- and right-sided perianastomotic veins were similar histologically, but left-sided veins had decreased expression of phosphorylated endothelial nitric oxide synthase (P = .0032) and increased numbers of α-actin-positive smooth muscle cells (P = .0022).
Left-sided arteriovenous grafts are associated with reduced short-term patency compared with right-sided grafts in the Yorkshire pig preclinical model of arteriovenous prosthetic grafts. Laterality must be considered in planning and interpreting surgical preclinical models.

View all citing articles on Scopus

View full text

Central venous stenosis in haemodialysis patients without a previous history of catheter placement

Abstract

Objective:

Material and methods:

Results:

Conclusion:

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Eur J Vasc Endovasc Surg

J Vasc Interv Radiol

Kidney Int

J Vasc Surg

Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses

Nephrol Dial Transplant