Central vein rupture during percutaneous transluminal angioplasty for central vein stenosis or occlusion in haemodialysis patients

Abstract

Background: Endovascular treatments such as percutaneous transluminal angioplasty (PTA) and stent placements are becoming the standard method in managing haemodialysis access failure. Venous rupture is the most common complication during endovascular procedures. Complications during endovascular treatments of central venous stenosis or occlusion have been rarely reported.Objectives: To investigate the incidence and management of central vein rupture while performing PTA for central vein stenosis or occlusion in haemodialysis patients.Method: Between 1998 and 2013, PTA was performed using various techniques in haemodialysis patients for central vein stenoses (n = 2437) and occlusions (n = 666). When the guide wire passed through the stenosis or the occlusion, PTA was performed regardless of the presence of a venous rupture. The incidence of central vein rupture was analysed using the chi-square test according to the gender, location, right versus left, presence of thrombosis and stenosis versus occlusion. Percutaneous management of central vein rupture was also evaluated.Results: Central vein rupture occurred in 12 cases (0.39%). All ruptures occurred in the cases with occlusion. Only stenosis versus occlusion reflected a significant correlation (p < 0.001) with central vein rupture. Central vein ruptures were managed by low-pressure balloon tamponade (n = 2), stent/stent-graft (n = 5) and balloon-mediated haemostasis blocking venous inflow followed by the observation (n = 5).Conclusion: Central vein rupture is a rarely occurring complication while performing PTA for central vein stenosis and occlusion, and the majority can be successfully managed by percutaneous techniques.

Factors Affecting Outcomes of Percutaneous Transluminal Angioplasty for Central Vein Occlusive Disease in the University of the PhilippinesPhilippine General Hospital: A 10-Year Experience

“…There was no mortality in Kim's series. 11 The complication rate in this series was also low (0.99%). In one patient, a hematoma at the puncture site was corrected by evacuation of clots and suturing of the access vein.…”

“…Other complications include arterial embolization and venous puncture. 11 Technical success ranges from 73-90%. Primary patency rates post-intervention at one month are 84%, three months at 55-80%, six months at 42-71%, and 12 months at 17-55%.…”

Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review

“…Lastly, care should be exercised during angioplasty of central venous stenoses (e.g., brachiocephalic vein, superior vena cava), as rupture in this location can lead to fatal cardiac tamponade. Kim et al ( 86 ) described an incidence of 0.39% of central vein rupture during angioplasty of central stenoses in hemodialysis access patients; these ruptures were treated with either balloon tamponade or stenting.…”