Successful Permanent Catheter Implantation After Percutaneous Transluminal Angioplasty to the Right Subclavian and Inominate Vein Stenosis in a Hemodialysis Patient

Abstract

Difficulties in gaining vascular access have become one of the major problems in long-term hemodialysis patients. We report a case with an extreme vascular access problem, which was solved by the placement of a permanent central vein catheter after successful angioplasty to the right subclavian and inominate vein stenosis. A 78-year-old woman with end-stage renal disease due to diabetic nephropathy had been on hemodialysis since 1982. She had a history of four procedures that created an arteriovenous fistula during the first four years. In 1986 she was switched to peritoneal dialysis. However, hemodialysis was restarted with a regular arteriovenous fistula in 1991 because of repeated peritonitis, and from 1993 a superficialized brachial artery was used until the artery was exhausted. Since 1997, a permanent central vein catheter was utilized and reinsertion was required four times due to catheter infection during a 6-year period. In 2004, difficulty was experienced in reinserting a new central venous catheter because of multiple stenotic and occlusive lesions of the central veins. Percutaneous transluminal angioplasty was carried out in the stenotic right subclavian and inominate veins, and after successful angioplasty, a permanent central vein catheter could be placed into the right subclavian vein as a vascular access for hemodialysis. Pretreatment with percutaneous transluminal angioplasty of the stenotic central veins before inserting a permanent catheter may be a useful strategy in patients that experience difficulty in the insertion of a catheter.

Hemodialysis Catheter Malposition Induced by a Brachiocephalic Vein Stenosed Stent

“…For patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, its insertion can be reliably achieved immediately after endovascular recanalization with acceptable technical and long-term success rates. 9 The left brachiocephalic stent stenosis causes regression of venous hypertension of a functioning vascular access in the ipsilateral upper extremity, as it had happened in our case. There are reports of hemodialysis catheter misplacement when insertion was attempted through a vein distally to left brachiocephalic vein that was hypoplastic, 2 stenosed, 3 or thrombosed.…”

Should Endovascular Intervention be the First Choice to Treat Central Vein Stenosis in Hemodialysis Population?

“…Most literatures [4][5][6], including the K/DOQI guidelines [15], recommend PTA, with or without stent placement as the preferred treatment approach to symptomatic CVS. Treatment with PTA and/ or stents is beneficial in maintaining dialysis access circuit patency (including AVF, AVG and PHC) [5,13,14,[16][17][18] and alleviating swelling of the ipsilateral arm, breast, or face in the short term [19]. But re-stenosis is one of main risks for treated CVS [20,21].…”