Endovascular treatment of type 3 and 4 thoracic central vein obstruction in hemodialysis patients

Uceda, Pablo V.; Feldtman, Robert W.; Peralta, Julio; Ahn, Sam S.

doi:10.1016/j.jvsv.2020.10.009

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…Meanwhile, severe problems were reported in other studies. 17,33,34,42 This might be explained by the use of vigorous techniques such as recanalization with a sharp needle, but that was not the case here. There were just a few arrhythmias detected during the passage of the wire that had accidentally entered the heart, and they were instantly identified by changes in ECG continuous monitoring and cured by withdrawing the wire outside the heart without serious effects.…”

Section: Discussionmentioning

confidence: 78%

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Midterm Results of Tunneled Catheter Placement in Hemodialysis Patients with Central Venous Stenosis or Occlusion

Lotfy

Elemam

Shaalan

et al. 2021

Ain Shams Journal of Surgery

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Background:Patients who suffers from central venous occlusion (CVO) or central venous stenosis (CVS) with no options for vascular access (VA) need urgent HD.Purpose: To evaluate CVO or CVS endovascular veinoplasty through an occluded access site to insert tunnelled catheter for HD.Patients and methods: Patients included had no options for VA and had CVO or CVS.Results: 124 patients on HD had endovascular veinoplasty. Technical success was 100% and 79% for CVS and CVO. Mean follow-up period was 36.16±12.6 months. Primary catheter site patency was 70%, 40%, 20%, and 5% after one, two, three, and four years. Assisted primary catheter site patency was 77%, 45%, 27%, and 12% and access vein survival was 100%, 80%, 40%, and 15% respectively at one, two, three, and four years, respectively. Conclusion:Recanalizing occluded veins for catheter insertion is simple, cost-effective, and safe.

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Section: Discussionmentioning

confidence: 78%

“…Multiple research projects demanded the use of a second entry point for CVO. 33,34 Percutaneous balloon venoplasty and endovascular stent implantation have evolved into the primary treatment options for CVS and CVO. We employed balloon dilatation only, without stenting.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Tunneled Catheter Placement in Hemodialysis Patients with Central Venous Stenosis or Occlusion

Lotfy

Elemam

Shaalan

et al. 2021

Ain Shams Journal of Surgery

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“…The key to endovascular treatment is guidewire passage through the occluded segment. However, in 42-49% of patients, there is a failure to cross lesions of the central vein using standard guidewire and catheter techniques (11,19). This is the first report to discuss the efficacy and safety of blunt impingement followed by the sharp recanalization in hemodialysis patients with CVO.…”

Section: Discussionmentioning

confidence: 94%

“…However, it has been reported that refractory CVO cannot be recanalized using traditional catheter and guidewire techniques (7,8). Therefore, sharp recanalization with more procedure-related complications, such as a Chiba needle, the stiff end of a hydrophilic wire, and transseptal needle, has been gradually applied to the treatment of challenging CVO (9)(10)(11). Currently, blunt impingement for refractory CVO is rarely reported.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

Sun¹,

Zhao²,

Salerno³

et al. 2022

Ann Transl Med

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Background: Central vein occlusion (CVO) is a serious problem in hemodialysis patients. There is an unsatisfactory result for refractory CVO by sharp recanalization alone. This study evaluated the efficacy and safety of blunt impingement followed by sharp recanalization for the treatment of CVO in hemodialysis patients.Methods: This study retrospectively examined hemodialysis patients with CVO who failed to recanalize using standard guidewire and catheter techniques in our department. In the first instance, all CVOs were recanalized using blunt impingement techniques, including a 6-Fr long sheath (Cook Incorporated, Bloomington, IN USA) and an 8-Fr sheath of Rosch-Uchida Transjugular Liver Access Set (RUPS-100; Cook Incorporated, Bloomington, IN, USA). If this was not successful, sharp recanalization devices were applied, including the stiff tip of a guidewire (Terumo, Tokyo, Japan), the RUPS-100, and the percutaneous transhepatic cholangial drainage (PTCD) needle (Cook Incorporated, USA). All patients were followed up at least 4 months postoperatively. The technical success rate, arteriovenous access patency rates, and operationrelated complications were analyzed. Results:The procedural success rate was 100.0% (30 of 30). Thirty patients with CVO underwent blunt impingement with a technique success rate of 70.0% (21 of 30), and 9 patients received sharp recanalization after failed blunt impingement, with a technique success rate of 100.0% (9 of 9). The primary patency rates at 6 and 12 months postoperatively were 86.7% and 53.3%, respectively. The primary assisted patency rates were 93.3% and 63.3%, and the secondary patency rates were 93.3% and 70.0% at 6 and 12 months, respectively. One major procedure-related complication was detected, namely, a small injury of the superior vena cava (SVC) wall in a patient receiving recanalization via the stiff end of a guidewire, but this did not require further treatment.Conclusions: It is potentially effective and safe for interventionalists to use blunt impingement followed by sharp recanalization techniques to treat chronic CVO that is refractory to traversal using traditional catheter and guidewire techniques.

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“…Percutaneous treatment options include angioplasty or angioplasty with stent placement. Uceda et al 25 recently described 45 patients with thoracic central venous obstruction. The initial technical success rate was 95.5%.…”

Section: Endovascular Techniquesmentioning

confidence: 99%

Stents in the Management of Stenotic and Occlusive Lesions in the Venous System

Lee

Hines

2021

Cardiology in Review

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Occlusive disease of the iliac veins or major intrathoracic veins have traditionally been managed by conservative management or by major vascular reconstructive procedures. Over the past 15-20 years, these lesions have become amenable to management with venous stents. Lesions in the iliac venous system are typically due to thrombus secondary to deep vein thrombosis, and lesions in the superior vena cava are due to either malignant intrathoracic lesions, indwelling central venous catheters, pacemaker leads, or enlarged nodes due to granulomatous disease. The success rate for implantation is between 92% and 95% and associated implantation complications vary between 2% and 5%. Primary patency of iliac stents is 70-90% at three years. Venous stents have higher patency in the treatment of stenotic lesions compared to totally occlusive lesions. Primary patency of stents placed in the superior vena cava is also about 70-90% and generally lower in lesions due to malignancy likely related to life expectancy. Stents in the venous system are associated with few complications at the time of insertion and have excellent long-term patency.

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Endovascular treatment of type 3 and 4 thoracic central vein obstruction in hemodialysis patients

Cited by 5 publications

References 26 publications

Midterm Results of Tunneled Catheter Placement in Hemodialysis Patients with Central Venous Stenosis or Occlusion

Midterm Results of Tunneled Catheter Placement in Hemodialysis Patients with Central Venous Stenosis or Occlusion

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

Stents in the Management of Stenotic and Occlusive Lesions in the Venous System

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