Central venous disease in hemodialysis patients

Abstract

Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.

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 .…”

Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue

“…Because of the design of this study, the CVS incidence is likely to be a considerable underestimation. CVOD in patients on dialysis without cardiac devices has been described extensively and the reported incidence varies from 4 to 41% [ 9 , 24 – 27 ]. Prevention of CVOD by minimizing exposure to well-established risk factors, such as the (duration of) use CVCs for vascular access, is of the utmost importance [ 11 , 28 ].…”

Dilatation of Superior Ophthalmic Vein and Visual Disturbance by Central Venous Stenosis: A Case Mimicking Cavernous Sinus Dural Arteriovenous Fistula

“…중심정맥질환은 완두, 쇄골하, 내경정맥 등의 중심정맥이 50% 이상 좁아지거나 폐쇄되는 병리적 상태를 말한다( 5 ). 주로 투석 중인 말기 신질환 환자에서 흔한 합병증으로 혈액 투석 환자의 20%–40%에서 다양한 형태로 나타날 수 있다( 1 ).…”

“…중심정맥협착은 혈액 투석을 받지 않는 환자에서는 보통 증상을 유발하지 않지만, 동정맥루를 이용하여 혈액 투석을 받는 경우에는 정맥협착과 정맥울혈로 인해 임상증상이 야기될 수 있다( 3 ). 증상은 주로 협착부위의 동측 팔과 안면의 부종으로 나타난다( 5 ). 경정맥역류가 진행되면 이로 인한 두개내압 상승이 드물게 동반될 수 있으며 지금까지 총 24명의 증례가 보고된 바 있다( 1 2 ).…”

“…수술은 중심정맥의 개통이 장기간 유지되는 장점은 있으나, 협착부위가 주로 흉부에 위치하고 있어 수술에 용이하지 않으며 중심정맥협착이 다발성으로 발생할 수 있기 때문에 흔히 시행되지는 않는다. 대신 풍선혈관성형술이나 스텐트 삽입술이 재발의 위험은 상대적으로 높으나 접근이 보다 용이하여 중심정맥협착의 치료로 주로 이용된다( 5 10 ).…”