Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient – Case Report and Literature Review

Abstract

SummaryBackgroundGiven the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains.Case Report61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by “body floss” technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self – expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center.ConclusionsMain objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.

The feasibility and safety of a through-and-through wire technique for central venous occlusion in dialysis patients

“…However, reported technical success rates, complications, and long-term outcomes of endovascular therapy varied greatly [1, 6, 9–14], which can be attributed to differences in recanalizing technique, study methodologies, patient demography, and certain characteristics of obstructive lesions including size and elasticity, as well as the degree of obstruction [1–4, 11, 15]. According to reports, technical success rates have been shown to have a range from 70% to 100% [1, 16]. However, we noted that clinical practice guidelines, such as the Kidney Disease Outcomes Quality Initiative (KDOQI) and the European Best Practice Guidelines (EBPG), were developed in 2002–2006 in developed countries [17, 18].…”

Recurrent syncope due to central venous occlusion in a patient undergoing hemodialysis

“…2 The prevalence of central venous stenosis or occlusion is 23% in the total hemodialysis population and up to 41% in those with vascular access-related problems. 3 The most common symptoms in patients with central venous stenosis or occlusion are ipsilateral upper extremity, facial and breast edema, superficial chest wall venous tortuous dilatation, 1 chest tightness, and dyspnea. 4 When patients present with neurological symptoms or signs, differential diagnosis requires consideration of cerebral hemorrhage, cerebral infarction, and other cerebrovascular lesions of the arterial system, as well as carotid-cavernous fistula and other disorders.…”

Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy

“…The technical success rates of PTA of CVO could be as high as 70% to 100% [10,11] ; however, there are still patients whose occlusion cannot be traversed using a conventional technique. For long segment CVO, the lesion usually involves more than 1 segment of central veins.…”