Results of Stenting for Central Venous Occlusions and Stenoses in the Hemodialysis Patients

Eguchi, Daihiko; Honma, Ken‐ichi

doi:10.3400/avd.oa.20-00114

Cited by 8 publications

(8 citation statements)

References 22 publications

(26 reference statements)

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“…2 One year stent patency in this setting exceeds 70%. 3 The self-expanding Wallstent is one option to treat central venous lesions and is intended to treat residual stenoses ≥30% for veins ≤10 mm in diameter and ≥50% for veins ≥10 mm in diameter for innominate and subclavian veins 8–15 mm in size that have previously failed balloon angioplasty. The unique braided wire scaffold design gives the stent a high degree of conformability and strength.…”

Section: Discussionmentioning

confidence: 99%

Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Schafer

Goldschmidt

Seiwert³

2022

Vascular

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Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient’s symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.

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Section: Discussionmentioning

confidence: 99%

Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Schafer

Goldschmidt

Seiwert³

2022

Vascular

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“…Although surgical treatment of central venous lesions has yielded good results, surgical procedures are more invasive than endovascular treatments and are usually not the first choice for therapy (14,15). Endovascular treatment remains the mainstay of treatment in hemodialysis of patients with CVO, with good efficacy and safety (3,(16)(17)(18).…”

Section: Discussionmentioning

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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“…1,[7][8][9][10][11][12][13][14][15] In our case, surgical ligation or obstruction was deemed implausible due to edema surrounding the AV shunt. Moreover, Eguchi and Honma reported that 69% of the case did not require reintervention for the original lesion 1 year after the stent placement against central venous lesion, 16) whereas Ashwal et al also reported that 33% did not require recurrent stenosis or reintervention 1 year after the endovascular therapy (i.e., percutaneous transluminal angioplasty with or without stent placement) for central venous lesion. 17) Given these low patency rates, the approach reported herein may be one of the potential alternatives for intervention against symptomatic CVD.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Cerebral Venous Circulation Dysfunction Caused by Hemodialysis Shunt: A Case Report

Ebihara

Sato

Ishikawa

et al. 2022

JNET

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Objective: Central venous disease, defined as ≥50% stenosis or obstruction of central veins, is one of many lifethreatening complications faced by patients on hemodialysis. It often presents as upper limb edema to the arteriovenous (AV) shunt for hemodialysis, although neurological symptoms are rare. We report a case of central venous disease with neurological symptoms associated with endovascular therapy.Case Presentation: A 79-year-old man presented with status epilepticus. His past medical history included rectal carcinoma when he was 69 years old and indication for hemodialysis when he was 79 years old. However, he had no history of neurological disease or epilepsy. On arrival at our facility, CT perfusion revealed venous circulation dysfunction on the left cerebral hemisphere. DSA demonstrated regurgitation from the AV shunt on left upper limb to the cerebral veins and obstruction of the left subclavian vein. Ligation of the causal AV shunt was deemed difficult due to surrounding edema; therefore, endovascular transarterial coil embolization was performed. After completely occluding the AV shunt, patient's condition improved significantly. The patient was discharged 3 days later without neurologic symptoms, with no recurrence of epilepsy was observed to date. Conclusion:Coil embolization of causal AV shunt significantly improved the neurological symptoms of central venous disease.

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Results of Stenting for Central Venous Occlusions and Stenoses in the Hemodialysis Patients

Cited by 8 publications

References 22 publications

Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

Surgical removal of a foreshortened right innominate vein Wallstent causing venous outflow obstruction

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

Endovascular Treatment of Cerebral Venous Circulation Dysfunction Caused by Hemodialysis Shunt: A Case Report

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