Hemoptysis after percutaneous transluminal angioplasty for left stenotic brachiocephalic vein in a patient on maintenance hemodialysis

The objectives of central venous percutaneous transluminal angioplasty are to dilate the venous lesion and to extend the life of arteriovenous fistula for hemodialysis. It is reasonable to perform percutaneous transluminal angioplasty for central venous lesions if this interventional therapy is required to maintain stable dialysis therapy. However, the presence of large fresh thrombus at central venous lesion site represents a contraindication to percutaneous transluminal angioplasty unless the thrombus can first be removed by thrombectomy. Balloon angioplasty is a basic treatment for central venous lesion, but stent implantation is sometimes required. The self-expandable or balloon-expandable stent is chosen by the lesion location and characteristics. The lesion in subclavian vein is generally treated by self-expandable stent and right brachiocephalic vein is treated by balloon-expandable stent. The organic lesion of innominate vein with plaque is treated by self-expandable stent. Note that the innominate venous stenosis is sometimes caused by compression between the right brachiocephalic artery and the sternum, and this lesion is treated by balloon-expandable stent because the radial force of balloon-expandable stent is stronger than self-expandable stent. It is important to understand the indication and stent selection for central venous percutaneous transluminal angioplasty.

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Percutaneous Transluminal Angioplasty of Brachiocephalic Vein Stenoses in Patients with Dialysis Shunts

Radiology ◽

10.1148/radiology.169.1.280-a ◽

1988 ◽

Vol 169 (1) ◽

pp. 280-280 ◽

Cited By ~ 2

Author(s):

Simon J. N. Daniell ◽

Janet E. Dacie

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Brachiocephalic Vein ◽

Percutaneous Transluminal

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Percutaneous transluminal angioplasty of brachiocephalic vein stenoses in patients with dialysis shunts.

Radiology ◽

10.1148/radiology.166.1.2962226 ◽

1988 ◽

Vol 166 (1) ◽

pp. 45-47 ◽

Cited By ~ 24

Author(s):

T L Ingram ◽

S H Reid ◽

J Tisnado ◽

S R Cho ◽

M P Posner

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Brachiocephalic Vein ◽

Percutaneous Transluminal

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Solutions to stuck tunneled cuffed catheters in patients undergoing maintenance hemodialysis

The Journal of Vascular Access ◽

10.1177/1129729820928163 ◽

2020 ◽

pp. 112972982092816

Author(s):

He Yongchun ◽

Jiang Hua ◽

Huang Xiaohan ◽

Chen Jianghua ◽

Zhang Ping

Keyword(s):

Success Rate ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Maintenance Hemodialysis ◽

Central Vein ◽

Blunt Dissection ◽

First Choice ◽

Vein Stenosis ◽

Percutaneous Transluminal

Objective: To study and discuss treatments for stuck tunneled cuffed catheter in patients undergoing maintenance hemodialysis. Method: Retrospectively analyzing clinical data of 13 patients with stuck tunneled cuffed catheter in the Kidney Disease Center of the First Affiliated Hospital, College of Medicine, Zhejiang University in the period between September 2012 and October 2018. All patients failed to remove hemodialysis catheters by regular technique. The stuck catheters were treated by thoracotomy, endoluminal percutaneous transluminal angioplasty with blunt dissection or embedded and left in situ. Results: In 13 patients, one was successfully treated by thoracotomy, one failed to remove the catheter by regular technique and blunt dissection, and the stump of the catheter was clamped and buried in the subcutaneous fascia of the neck, and the other 11 were treated by endoluminal percutaneous transluminal angioplasty with blunt dissection. The average time of catheter removal procedure is 25 min, the overall success rate is 92.3%, and the success rate of percutaneous transluminal angioplasty is 100%. Conclusion: Thoracotomy is an efficient way to treat stuck catheter but is limited by its high risk and complications. Leaving part of catheter in situ may increase the risk of central vein stenosis. Comparing to the former two, endoluminal percutaneous transluminal angioplasty is a safe, efficient, and practical way for stuck catheters and should be recommended as the first choice.

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