Screening for Carotid Artery Stenosis and Renal Artery Stenosis in Patients Undergoing Tunneled Cuffed Hemodialysis Catheter Placement

Abstract

In this study, we noted the common risk factors with atherosclerosis and chronic renal disease. We, therefore, hypothesized that the placement of a dialysis catheter would be a useful marker in identifying populations at increased risk of vascular disease (carotid, renal, and aortic). To further explore this issue, we examined the results of duplex scanning of the carotid arteries and aortorenal arteries in patients undergoing dialysis catheter placement. Over 49 months, each of the 123 patients who underwent permanent tunneled dialysis catheter placement received a carotid duplex study. Twelve patients (9.8%) had ≥ 60% stenosis and 8 patients (6.5%) had 70% to 99% stenosis. Furthermore, 109 patients who underwent a aortorenal artery duplex study were also analyzed. The study population demonstrated a prevalence rate of 3.7% for abdominal aorta aneurysm (AAA) and 4.6% for renal artery stenosis (RAS). Based upon these data, we suggest performing routine carotid duplex scans in patients who will also receive dialysis catheter placement. However, the data did not support routine screening of AAA or RAS.

Changes in cerebral oxygenation during hemodialysis before and after carotid artery stenting

“…In patients undergoing HD, the prevalence of carotid artery stenosis is approximately 6% to 10%, which is 5- to 10- fold higher than that of the general population [2] , [3] , [4] . Regarding the efficacy of carotid revascularization in stenosis, the threshold for achieving surgical benefit in asymptomatic patients with at least a 3-year life expectancy and stenosis >60% is recommended not to exceed 3% in the perioperative stroke and death rate [ 6 , 9 ].…”

“…Cerebrovascular disease is the fourth leading cause of death, which occupies 6.0%, and its prevention is critical in the field of dialysis therapy in Japan [1] . Furthermore, in patients undergoing hemodialysis (HD), diabetes mellitus and hypertension resulting in chronic kidney disease (CKD) and CKD-mineral and bone metabolism disorders are frequently associated with accelerated atherosclerosis and could lead to the high prevalence of carotid artery stenosis [2] , [3] , [4] . Carotid artery stenting (CAS) is considered feasible and effective for the prevention of cerebrovascular disease because of the recent favorable findings of carotid revascularization, including CAS, for the dialysis patients with carotid artery stenosis [ 5 , 6 ].…”

Prevalence of severe carotid artery stenosis and its association with echocardiographic parameters in maintenance hemodialysis patients

“…Supporting this, a recent work on screening for carotid artery stenosis reported a prevalence of 9.8% in patients with ≥60% stenosis and 6.5% in patients with 70-99% stenosis. [23] This number belonged to patients undergoing tun- rosis with further comorbidity, such as hypertension, known to reduce LV systolic function. Additionally, increased CIMT might lead to diastolic dysfunction [46] by increasing afterload due to increased arterial stiffness and collagen deposition, [47] which causes an enhanced augmentation index.…”

Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease

“…75,79 Other investigators have noted that the prevalence of occult carotid stenosis is increased in those with diabetes compared with those without diabetes (8.7% vs 2.8%; P < .01) 80 and in patients requiring hemodialysis and undergoing tunneled catheter placement (9.8%). 81 In a study of 1500 subjects specifically recruited for carotid screening, the overall prevalence of significant stenosis was 5.2%. The independent predictors of an increased prevalence of carotid stenosis included hypertension, diabetes mellitus, cigarette smoking, hypercholesterolemia, and a family history of stroke.…”