Subclavian Vein Stenosis as a Complication of Subclavian Catheterization for Hemodialysis

Spinowitz, Bruce; Galler, Marilyn; Golden, Ronald A.; Rascoff, Joel H.; Schechter, Lawrence S.; Held, Barry T.; Charytan, Chaim

doi:10.1001/archinte.1987.00370020123048

Cited by 68 publications

(19 citation statements)

References 7 publications

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“…The SCV route is generally avoided because the rate of central vein stenosis is high, precluding the use of the entire arm for access (10). The FV has been explored as a route of long-term access placement (grafts or catheters) by a few researchers (11,12) The current weight of evidence supports the use of shared governance in making this decision (13,14).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Femoral Dialysis Access Placement

Prabhu¹,

Juneja²,

Gopal³

et al. 2010

Clinical Journal of the American Society of Nephrology

119

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Background and objectives: Insertion of dialysis catheters (DCs) is a prerequisite for successful initiation of hemodialysis. We attempted to determine if ultrasonography-guided (USG) insertion was superior and safer than the anatomical landmarkguided technique (ALT) for the femoral vein (FV).Design, setting, participants, & measurements: This was a randomized prospective study on 110 patients requiring FV DCs in a tertiary care hospital. Patients were randomized into two groups: USG and ALT. Data were collected on demography, operator experience, and side of insertion. The USG group had their catheters inserted under USG guidance, whereas the ALT group had their DC inserted by ALT. Outcome measures included successful insertion of DC, number of attempts, and complications.Results: Both groups were comparable regarding age and gender of patients, operator experience, and the side of catheterization. The overall success rate was 89.1%, with 80% using ALT and 98.2% under USG guidance (P ‫؍‬ 0.002). First attempt success rate was 54.5% in the ALT group as compared with 85.5% in the USG group (P ‫؍‬ 0.000). The complication rate was 18.2% in the ALT group and 5.5% in the USG group (P ‫؍‬ 0.039). The odds ratio (OR) for complications with two or more attempts was 10.73 with a relative risk (RR) of 3.2. The OR for successful insertion using USG was 13.5 (95% CI: 1.7 to 108.7).Conclusions: USG significantly improves success rate, reduces number of attempts, and decreases the incidence of complications related to FV DC insertion.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Femoral Dialysis Access Placement

Prabhu¹,

Juneja²,

Gopal³

et al. 2010

Clinical Journal of the American Society of Nephrology

119

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“…Stenoses and occlusions of central veins may occur after repeated or prolonged catheterization for hemodialysis access [1][2][3] . If the draining vein of a functioning shunt is obstructed, extreme venous hypertension can develop and result in pain, incapacitating swelling, and venous stasis ulcers of the arm, chest, neck and face on the ipsilateral side [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Acute Intracranial Hypertension due to Occlusion of the Brachiocephalic Vein in a Patient Undergoing Hemodialysis

Nishimoto

Ogasawara²,

Miura³

et al. 2005

Cerebrovasc Dis

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“…Thrombosis-stenosis of a subclavian vein is a poten tially serious complication of the subclavian route for HD and nowadays has become a frequent disturbance due to the wide and prolonged use of subclavian dialysis catheters [4][5][6][7]. This is particularly evident after the arte riovenous fistula has been created on the same side as previous subclavian catheterization was performed and often requires removal of the arteriovenous fistula and complicates future fistula replacement [6,7], The mechanism causing this subclavian thrombosisstenosis is unknown, although several factors have been related.…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly evident after the arte riovenous fistula has been created on the same side as previous subclavian catheterization was performed and often requires removal of the arteriovenous fistula and complicates future fistula replacement [6,7], The mechanism causing this subclavian thrombosisstenosis is unknown, although several factors have been related. Mural thrombosis occurring due to venous wall trauma, fibrosis caused by constant movement of the catheter in and out of the subclavian vein during HD, leaking of the plasticizers from the catheter at the side of contact with the vessel wall, and, finally, the role of venous hyperpressure induced by the arteriovenous fis tula are some of the reported factors [5,7]. Thrombosisstenosis of a subclavian vein may remain clinically silent, and in most instances detection resulted from a phlebo graphy done because of elevated venous pressure during HD or arm edema, and collateral circulation develops only after vascular access is attempted on the ipsilateral side.…”

Section: Discussionmentioning

confidence: 99%