Complications of Vascular Access: Superior Vena Cava Syndrome

Agarwal, Anil; Khabiri, Hooman; Haddad, Nabil J.

doi:10.1053/j.ajkd.2016.08.040

Cited by 26 publications

(26 citation statements)

References 13 publications

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“…7 Several endovascular techniques including thrombolysis, percutaneous transluminal angioplasty (PTA), stent placement have been widely applied in CVO in hemodialysis patients with variable success rates and long-term patency. Sharp transversal followed by conventional angioplasty was capable in restoring SVC patency in the majority of the included patients.…”

Section: Discussionmentioning

confidence: 99%

“…SVC occlusion threatens the availability of vascular access for hemodialysis, not only jeopardizing catheter patency, compromising venous drainage, but also making it difficult for new catheter insertion or fistula maturation. 7 Several endovascular techniques including thrombolysis, percutaneous transluminal angioplasty (PTA), stent placement have been widely applied in CVO in hemodialysis patients with variable success rates and long-term patency. 10 Patients who were resistant to standard interventional techniques would be sometimes provided with atypical access such as transhepatic and translumbar catheters, but the durability of these catheters are often questionable.…”

Section: Discussionmentioning

confidence: 99%

“…3 For patients refractory to conventional guide wire transversal, SVC sharp recanalization might be an option. 7 In 2016, Arabi and colleagues reported a series of seven chronic hemodialysis patients with CVO successfully treated by sharp recanalization; however, 2 major complications occurred including a right hemothorax and a small hemopericardium. [4][5][6] Although sharp recanalization has long been readily available, its application is limited by the relative lack of control over the exact trajectory of the wire or needle, which could be too peripheral within the occluded vessel or even extravascular.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Although sharp recanalization has long been readily available, its application is limited by the relative lack of control over the exact trajectory of the wire or needle, which could be too peripheral within the occluded vessel or even extravascular. 7 In 2016, Arabi and colleagues reported a series of seven chronic hemodialysis patients with CVO successfully treated by sharp recanalization; however, 2 major complications occurred including a right hemothorax and a small hemopericardium. 8 Moreover, the close relationship between SVC and right atrium warrants special attention to potential cardiac complications during SVC angioplasty.…”

Section: Introductionmentioning

confidence: 99%

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The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Yang

Zhao

et al. 2019

Hemodialysis International

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Introduction: Hemodialysis catheter-related superior vena cava (SVC) occlusions can cause considerable morbidity for patients and be challenging to treat if refractory to conventional guide wire transversal. This pilot study assessed the feasibility and safety of sharp recanalization of SVC occlusion in hemodialysis patients.Methods: This study retrospectively enrolled hemodialysis patients treated in West China Hospital diagnosed with SVC occlusion who failed traditional guide wire transversal from January 2014 to November 2017. In brief, a guide wire from the femoral approach was advanced to the lower end of the obstructive lesion to act as a target, while the stiff end of hydrophilic wire was advanced though a jugular approach. Under fluoroscopic guidance in biplane imaging, the occlusive SVC lesion was penetrated with the stiff wire that was snared and pulled through. Graded dilation of the SVC and subsequent tunneled-cuffed catheter implantation were performed. Demographic information and clinical outcomes were recorded and evaluated.Findings: Sixteen patients with a mean age of 62 AE 13 years (13 females and 3 males) who received SVC sharp recanalization were included in this study. The sharp recanalization procedure was successfully performed in 14 patients (87.5%). Two patients were complicated with SVC laceration and hemopericardium but remained asymptomatic and required no surgical repair. One patient suffered ventricular fibrillation during procedure. Despite the return of spontaneous circulation, the patient unfortunately died of gastrointestinal tract bleeding after 3 days in ICU. Follow-up suggested the 6-month catheter patency to be 92.85% and 12-month catheter patency to be 58.33%. No long-term procedure-related complications were recorded.Discussion: Sharp recanalization might be a feasible strategy in managing SVC occlusion in hemodialysis patients. The potential life-threatening complications (cardiac arrhythmia and SVC Correspondence to: laceration) necessitate strict eligibility screening, skillful operation, and avoidance of over-dilation of SVC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: A retrospective cohort study

Yang

Zhao

et al. 2019

Hemodialysis International

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“…Another concern over catheter use is central venous stenosis. Less studied than infection, the pathogenesis is poorly understood, but it is thought to involve elements of trauma, inflammation, and coagulation, and many important clinical questions remain unanswered (3,(12)(13)(14). Although central venous stenosis is known to be associated with catheter access, it does not affect all patients after a catheter, and it is unclear whether the extent of catheter use or other factors account for this variability.…”

Section: Introductionmentioning

confidence: 99%

Central Venous Stenosis, Access Outcome and Survival in Patients undergoing Maintenance Hemodialysis

Adwaney

Lim

Blakey

et al. 2019

CJASN

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Background and objectives Central venous catheters have traditionally provided access for urgent hemodialysis, but are also sometimes advocated as an option for older or more comorbid patients. Adverse effects of this type of dialysis access include central venous stenosis, for which the risk factors and consequences are incompletely understood.Design, setting, participants, & measurements We conducted two studies within the same population cohort, comprising all patients starting hemodialysis in a single center from January 2006 to December 2013. First, patients were retrospectively analyzed for the presence of central venous stenosis; their access outcomes are described and survival compared with matched controls drawn from the same population. Second, a subset of patients with a history of catheter access within this cohort was analyzed to determine risk factors for central venous stenosis.Results Among 2811 patients, central venous stenosis was diagnosed in 120 (4.3%), at a median dialysis vintage of 2.9 (interquartile range, 1.8-4.6) years. Compared with matched controls, patients with central venous stenosis had similar survival (median 5.1 versus 5.2 years; P=0.54). Among a subset of 500 patients, all with a history of catheter use, 34 (6.8%) developed central venous stenosis, at a rate of 2.2 per 100 patient-years. The incidence of central venous stenosis was higher with larger number of previous catheters (relative risk [RR], 2.2; 95% confidence interval [95% CI]. 1.6 to 2.9), pacemaker insertion (RR, 3.9; 95% CI, 1.7 to 8.9), and was lower with older age (RR, 0.7 per decade; 95% CI, 0.6 to 0.8). In a Cox proportional hazards model, the catheter number, pacemaker, and younger age at dialysis initiation were all significant independent risk factors for central venous stenosis.Conclusions Central venous stenosis occurred in a minority of patients on hemodialysis, and was associated with compromised future access, but unchanged survival. Among patients with a history of catheter use, risk related to both the number of catheters and the total catheter duration, although nondialysis factors such as pacemakers were also important. Central venous stenosis risk was lower in older patients, supporting the selective use of tunneled catheters in this group.Published online ahead of print. Publication date available at www. cjasn.org.

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