Mid-term Outcomes of Patients with Central Venous Occlusive Disease Undergoing Surveillance Venography and Intervention

Abstract

Introduction: To evaluate the mid-term outcomes of regular surveillance venography with or without percutaneous transluminal angioplasty in haemodialysis patients presenting with central venous occlusive disease. Materials and Methods: A single-centre retrospective analysis of haemodialysis patients who presented with central vein occlusion (CVO) and central vein stenosis (CVS) between January 2008 and December 2011 was performed. CVO and significant CVS were defined as 100% and >50% luminal narrowing respectively. Upon successful angioplasty on first presentation, patients were followed up with regular surveillance venography within 3–6 months of the intervention and were re-treated when a significant stenosis or occlusion was demonstrated. Data on patient’s demographics, comorbidities, presenting symptoms, type of upper limb dialysis access, lesion characteristics and complications were collected. Technical success, primary patency and primary assisted patency were analysed. Results: Thirty-five patients with CVO and 77 patients with CVS were enrolled. The technical success of initial PTA was 77% and 73% for the CVO and CVS groups, respectively. The primary patency at 3 months was 65% and 55% for the CVO group and CVS group, respectively (P = 0.32). The primary assisted patency at 1 year was 88% and 99% for the CVO group and CVS group, respectively (P = 0.009). At 2 years, the primary assisted patency were 77% and 90%, respectively (P = 0.07). There was significant difference in the overall primary assisted patency (P = 0.048) between the CVO and CVS groups. Conclusion: CVOs are more difficult to treat than CVS. High primary assisted patency rates can be achieved with surveillance venography, albeit at the expense of increased number of interventions. Further cost effectiveness studies need to be performed to study the true benefit of our surveillance programme. Ann Acad Med Singapore 2020;49:360–66 Key words: Dialysis circuit, End stage renal failure, Renal replacement therapy

Factors Affecting Outcomes of Percutaneous Transluminal Angioplasty for Central Vein Occlusive Disease in the University of the PhilippinesPhilippine General Hospital: A 10-Year Experience

“…The latter is reported in current literature with one month at 84%, three months at 55-80%, six months at 42-71%, and 12 months at 17-55%. [12][13][14][15] In our patients (n=19), it ranged from twelve (3 months) to one hundred ninety-two weeks (48 months). Although very wide in range, this data must be interpreted cautiously as we have limited cases of multiple intervention CVOD.…”

“…Primary patency rates post-intervention at one month are 84%, three months at 55-80%, six months at 42-71%, and 12 months at 17-55%. [12][13][14][15] The first Percutaneous Transluminal Angioplasty (PTA) for CVOD was done in the Philippine General Hospital in 2013. 16 Local studies or data are limited in the Philippines.…”

Predictors for development of critical illness amongst older adults with COVID-19: Beyond age to age-associated factors

“…High acuity of clinical presentation was defined as presence of any of the following: symptoms of dyspnea, temperature >38 °C, systolic blood pressure <100 mmHg, or heart rate > 100 beats per minute. Cutoffs for vital sign derangement were derived from the modified Severity of Illness Index, a validated 4-level burden of illness measure ( Wong, Sahadevan, Ding, Tan, & Chan, 2010 ). The advantage of using vital signs and presenting symptom as a measure of illness acuity is that it can assessed quickly without the need for laboratory and radiological data.…”