P1359PATTERNS OF CENTRAL VENOUS OBSTRUCTION AND OUTCOMES OF ENDOVASCULAR INTERVENTIONS IN CKD PATIENTS ON HAEMODIALYSIS

Abstract Background and Aims Central Venous Obstruction (CVO) is one of the major causes of morbidity in Chronic Kidney Disease (CKD) patients on maintenance Hemodialysis (HD). The aim of the study was to assess the patterns of CVO and the role of Endovascular interventions to restore the patency of vascular access in patients on HD with CVO. Method We report 15 cases of CVO in HD patients between April 2015 to April 2018. Data regarding patients’ basic information, primary disease, dialysis duration, access at initiation, number and sites of central venous catheterizations, vascular segments stenosed or thrombosed, type of endovascular interventions done and outcomes were collected from electronic record system. Results Out of 15 cases of CVO, 11 had the first dialysis with a temporary catheter either to Internal Jugular vein or femoral vein. The average time of presentation to our hospital from initiation of dialysis was 14.8 months. 8 patients presented with symptomatic SVC obstruction. The most common site of CVO was left Brachio-cephalic vein followed by right brachio-cephalic, right subclavian and left subclavian vein. 12 patients underwent Percutaneous Transluminal Angioplasty (PTA) and 3 required bare metal stenting (BMS) along with PTA. One patient required repeat PTA after 4 months. 11 patients did not require further procedure in the mean follow up period of 110 days. PTA was found to be successful in 11 out of 12 cases. Post PTA 9 patients underwent tunneled HD catheter insertion. Conclusion Patients of CKD who present late to the nephrologists require HD to be initiated through temporary catheters to central veins. Repeated central venous catheterization is associated with CVO. Endovascular intervention is an effective modality for maintaining HD access patency in such cases.

Download Full-text

Salvage of a dialysis angioaccess by bypassing a central venous obstruction to the common femoral vein

VASA ◽

10.1024/0301-1526.38.3.245 ◽

2009 ◽

Vol 38 (3) ◽

pp. 245-248 ◽

Cited By ~ 1

Author(s):

Asciutto ◽

Mumme ◽

Asciutto ◽

Geier

Keyword(s):

Upper Extremity ◽

Femoral Vein ◽

Postoperative Recovery ◽

Venous Hypertension ◽

Venous Obstruction ◽

Central Venous ◽

Venous Bypass ◽

Common Femoral Vein ◽

The Common ◽

Central Venous Obstruction

We describe the case of a 71 year-old male patient undergoing haemodialysis who presented with severe symptoms of venous hypertension at the left upper extremity due to subclavian and innominate vein obstruction. The patient had a well functioning ispilateral angioaccess. The pain and disabling swelling of the upper extremity developed 12 months after having a radio-cephalic arteriovenous fistula performed and progressively worsened in the last two months. The patient underwent extraanatomic axillo-femoral venous bypass grafting with a 8 mm polytetrafluoroethylene graft to the ispilateral common femoral vein. The postoperative recovery was regular and the patient was discharged 6 days after surgery with a functioning bypass and relief from the venous hypertension symptoms. In this case, surgical bypassing of a central venous obstruction through an extra-anatomical pathway relieved the symptoms of venous hypertension and prolonged the use of the haemodialysis access.

Download Full-text

Central Venous Stenosis in a Patient on Maintenance Hemodialysis: A Case Report

BIRDEM Medical Journal ◽

10.3329/birdem.v9i1.39731 ◽

2019 ◽

Vol 9 (1) ◽

pp. 82-84

Author(s):

Tanveer Bin Latif ◽

Jan Mohammad

Keyword(s):

Chronic Kidney Disease ◽

Case Report ◽

Clinical Suspicion ◽

Brachiocephalic Vein ◽

Maintenance Hemodialysis ◽

Venous Obstruction ◽

Central Venous ◽

Central Venous Stenosis ◽

Percutaneous Transluminal ◽

Central Venous Obstruction

A 57-year-old male patient of chronic kidney disease on maintenance hemodialysis via right radio-cephalic fistula presented with swelling of his right arm and right half of face and headache. With the clinical suspicion of central venous obstruction he underwent venogram of right upper limb. A stenosis was found in right brachiocephalic vein. He underwent a percutaneous transluminal balloon angioplasty and his symptoms improved substantially. Birdem Med J 2019; 9(1): 82-84

Download Full-text