Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy

Zhao, Yuliang; Yang, Luxi; Mai, Hongxia; Yu, Yang; Fu, Ping; Cui, Tianlei

doi:10.1097/md.0000000000015208

Cited by 5 publications

(6 citation statements)

References 10 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: 77%

“…15 Percutaneous endovascular therapy, which has essentially supplanted surgical treatment in recent years, offers a less invasive management approach associated with decreased morbidity and mortality. [16][17][18] To effectuate dialysis, urgent, rapid, reliable, and safe access is needed in the event of a patient on regular dialysis with CVO or CVS who has exhausted all vascular options, which is considered a lifethreatening situation.…”

Section: Introductionmentioning

confidence: 99%

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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: 77%

Section: Introductionmentioning

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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“…It is easier in recanalization of partly RBV occlusion, and there were many methods to make it come true, including mother-child technique, extra stiff guidewire, through-andthrough wire technique, segmented sharp recanalization strategy, as well as using transseptal needle (30)(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

“…It is caused by mechanical damage to vessel walls from catheter insertion, as well as high flow rate of a preexisting arteriovenous fistula, resulting in intimal hyperplasia, fibrosis, endothelial cell dysfunction, and narrowing and occlusion of blood vessels (1)(2)(3). This can reduce the efficacy of hemodialysis by causing ipsilateral limb swelling and vascular access dysfunction, ultimately increasing allcause mortality (4). In day-to-day clinical practice, effective and safe treatment approaches are gradually developing, involving surgical and endovascular intervention.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients

Yin¹,

Shen²,

Zhou³

et al. 2020

Ann Transl Med

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Background: Whilst there are effective techniques for the recanalization of central venous occlusions, recanalization of chronic total occlusions remains particularly challenging. This study aims to evaluate the safety and efficacy of recanalization using a transseptal needle in chronic total occlusions of the right brachiocephalic vein (RBV) in long-term hemodialysis patients.Methods: In this single-center, retrospective study, maintenance hemodialysis patients with chronic total occlusion of the RBV were enrolled between February 2017 to March 2019 from West China Hospital of Sichuan University. Refractory lesions were defined as complete vascular occlusions with failed recanalization using conventional techniques. Occlusions were approached using a transseptal needle to penetrate which offers an alternative strategy with firm support force. Patient data, treatment outcomes and patency rates were collected and analyzed to assess the safety and efficacy of the technique.Results: A total of 16 eligible patients were analyzed. The operation was successful in 13 of the 16 patients and the success rate was 81.25% (13/16). Twelve patients underwent percutaneous balloon dilatation and stent implantation after sharp recanalization, whilst one patient underwent balloon dilatation only. We achieved procedural success in 13 patients without surgical complications, and all of the patients were discharged in a stable condition. The primary patency rates at 3, 6 and 12 months after surgery were 100%, 84.6% and 69.2%, respectively. The primary assisted patency rates were 100%, 84.6% and 76.9%, respectively, and the secondary patency rates were 100%, 84.6% and 76.9%, respectively.Conclusions: This study demonstrates that recanalization of chronic total occlusions to the RBV using a transseptal needle is a safe and effective method after traditional guide wire and catheter techniques fail.It was also found that additional techniques are needed for recanalization in patients with RBV occlusion combined with proximal stenosis or occlusion of the right subclavian vein.

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“…While the mainstream treatment of brachiocephalic vein occlusion is interventional angioplasty, other therapeutic options include surgical bypass, sharp recanalization, radiofrequency recanalization and outback reentry device. Sharp recanalization is a practical strategy to restore central vein patency when the occlusive lesion cannot be treated with blunt guidewire technique (15,16). According to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, the EJV can be as an alternative point of access in patients with occlusion of the IJV (9).…”

Section: Discussionmentioning

confidence: 99%

Sharp recanalization of the brachiocephalic vein occlusion through the external jugular vein in hemodialysis patients

Zhao¹,

Lin²,

Yang³

et al. 2020

Ann Transl Med

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Background: Although the internal jugular vein (IJV) is the most widely used puncture site in hemodialysis catheter insertion and central vein angioplasty, the external jugular vein (EJV) offers an alternative vascular access point in cases when the IJV is inaccessible. The present study aims to observe the efficacy and safety of sharp recanalization of the brachiocephalic vein occlusion through the EJV in hemodialysis patients.Methods: This retrospective study enrolled a cohort of hemodialysis patients who received sharp recanalization of occlusive brachiocephalic vein through the EJV at a university-affiliated hospital between January 2017 and January 2019. The demographic information and clinical outcome data of the patients were collected and analyzed.Results: A total of 16 hemodialysis patients who received right brachiocephalic vein sharp recanalization through the EJV were analyzed. The technical success rate was 100%. Twelve patients (12/16, 75%), whose EJV-subclavian vein angle (E-S angle) was 60-80 degrees, were successfully recanalized on the first attempt.With the other 4 patients (4/16, 25%), whose E-S angle approached 90 degrees, the brachiocephalic vein was recanalized on the second attempt by elevating the ipsilateral shoulder, therefore decreasing the E-S angle to align the course of the EJV with the brachiocephalic vein. Three minor complications were recorded, including 1 patient with blood continuously oozing from the EJV at the puncture site and 2 patients with mild chest pain. After an average of 10 months of follow-up, the clinical patent rate was 81.25% with no procedure-related complications reported.Conclusions: Sharp recanalization through the EJV could be an effective and safe alternative treatment for right brachiocephalic vein occlusion in hemodialysis patients if performed by an experienced practitioner.Measuring the angle formed by the EJV and the subclavian vein might provide helpful information for selecting patients.

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Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy

Cited by 5 publications

References 10 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

Efficacy and safety of recanalization with transseptal needle for chronic total occlusion of the brachiocephalic vein in hemodialysis patients

Sharp recanalization of the brachiocephalic vein occlusion through the external jugular vein in hemodialysis patients

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