Venous stenosis and occlusion in hemodialysis shunts: follow-up results of stent placement in 65 patients.

Vorwerk, Dierk; Guenther, Rolf W.; Mann, Howard; Bohndorf, Klaus; Keulers, P; Alzen, G.; Sohn, Michael; Kistler, D.

doi:10.1148/radiology.195.1.7892456

Cited by 152 publications

(82 citation statements)

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“…They are the result of connective tissue growing into the puncture tracts and can be successfully treated via PTA [21]. Supplementary stent implantation should be taken into consideration in recurrent stenoses [62]. In the case of repeat stent occlusion, it is necessary to surgically place the graft again.…”

Section: Insufficient Dialysis Graftmentioning

confidence: 99%

“…In the case of minimal dilation, there are increased recurrent stenoses with correspondingly lower long-term patency [61]. There are possible indications for additional stent implantation in the case of an insufficient PTA result and central venous stenoses and in the case of complications such as dissections or vascular perforations [62,63]. In total, endovascular treatment complications in the case of dialysis vascular access are rare [64].…”

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confidence: 99%

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Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

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Section: Insufficient Dialysis Graftmentioning

confidence: 99%

mentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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“…Indeed, the Society of Interventional Radiology (SIR) guidelines have indicated stent placement for central vein lesions (30). Some investigators have even argued that central venous lesions represent a primary indication for stent placement due to the poor outcome usually found with balloon dilation alone (18,31). The work of Gerald Beathard supports this assertion (32).…”

Section: Stents and Central Venous Stenosismentioning

confidence: 99%

Stent Placement in Hemodialysis Access

Yevzlin

Asif

2009

Clinical Journal of the American Society of Nephrology

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Vascular access stenosis in patients undergoing chronic hemodialysis is a major issue that is associated with increased morbidity, mortality, and cost of medical care. Recent data have emphasized that endovascular stents could be used in the treatment of central as well as peripheral stenotic lesions. In general, a peripheral or central vein lesion that is elastic or recurs within a three-month period after an initially successful balloon angioplasty or a stenosis where surgical revision is not possible are some indications for intravascular stent placement. Recent reports have expanded the role of stents in the management of pseudoaneurysms associated with dialysis access. In this context, the utilization of these devices must take into account a fair comparison with the traditional (surgical) approaches regarding effectiveness as well as costs. This report describes the role of stents in arteriovenous dialysis access. In addition, some of the recent advances in the structure and complicating issues such as stent fracture, migration, and infection, as well cannulation through the stent, are discussed.

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“…Results after PTA with stenting are quite inhomogeneous, with primary patency ranging from 60% to 28%, and secondary patency between 84% to 33% after 2 years. 5,[8][9][10] Using a covered stent or the use of endovascular brachytherapy seems not to enhance the patency rate. 11,12) Several anatomical changes inside the central veins may predispose to PTA failure.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

Acri

Carmignani

Vazzana

et al. 2013

ATCS

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Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain. We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension. In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.

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Venous stenosis and occlusion in hemodialysis shunts: follow-up results of stent placement in 65 patients.

Abstract: Stent placement in hemodialysis fistulas helps treat lesions that cannot be adequately treated with percutaneous transluminal angioplasty (PTA) alone but has a follow-up patency rate similar to that of PTA. Standard central venous stents have a better patency rate than after PTA.

Cited by 152 publications

References 0 publications

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Stent Placement in Hemodialysis Access

Ipsilateral Jugular to Distal Subclavian Vein Transposition to Relieve Central Venous Hypertension in Rescue Vascular Access Surgery: A Surgical Report of 3 Cases

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