<p>Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease</p>

Abstract

Purpose: Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis. Patients and Methods: The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson's chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs. Results: The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01). Conclusion: Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.

Reduction in hemodialysis catheter‐related bloodstream infections after implementation of a novel care program

“…Repeated insertion of a central venous catheter and duration of use are known risk factors for central venous stenosis 22,23 . Central veins include the superior and inferior vena cava, internal jugular veins, subclavian veins, brachiocephalic veins, and iliac veins 22,23 . The axillary, femoral and external jugular veins are not central veins 22 .…”

“…22,23 The axillary, femoral and external jugular veins are not central veins. 22 To prevent central venous stenosis, catheters inserted in femoral veins are used in hemodialysis units. Studies have reported a higher incidence of CRBSIs if catheters are inserted in femoral veins than if they are inserted in the jugular or subclavian veins.…”

“…22,23 Central veins include the superior and inferior vena cava, internal jugular veins, subclavian veins, brachiocephalic veins, and iliac veins. 22,23 The axillary, femoral and external jugular veins are not central veins. 22 To prevent central venous stenosis, catheters inserted in femoral veins are used in hemodialysis units.…”

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

“…Lesions resulting from multiple catheter insertions are associated with occlusive-type lesions. 22 Occlusive lesions, coupled with more events of vessel injury during multiple catheter insertions, may develop lesions that are hard to cross with a guidewire, leading to failed PTA. Our findings corroborate the inferences, where more central line insertions exist in our patients with failed intervention.…”

Heme Oxygenase 1/Peroxisome Proliferator-Activated Receptor Gamma Pathway Protects Intimal Hyperplasia and Mitigates Arteriovenous Fistula Dysfunction by Regulating Oxidative Stress and Inflammatory Response

“…The one-year patency of AVF is approximately 70%, the two-year patency is 65%, and the four-year patency is 48% [4]. Among them, the number of hospitalized patients due to vascular access stenosis and embolization accounted for 15%-24% of the total number of patients hospitalized for dialysis treatment [5]. Therefore, to prolong the life of maintenance hemodialysis patients, there is an urgent need to develop novel therapeutic targets and pathways to control AVF dysfunction.…”