Cerebral hyperperfusion and other consequences of hemodialysis central vein catheters

While central venous stenosis is a common consequence of protracted central venous catheter use, intracardiac device transvenous leads, and central venous instrumentation, the majority of patients who develop symptomatic central venous stenosis present with characteristic venous hypertension. However, some patients may develop an abnormal intracranial venous circulation and present with neurologic symptoms. This paper will summarize findings from case reports that describe the neurologic sequelae that can develop as a result of central venous stenosis/occlusion in end-stage renal disease patients with a functional arteriovenous access.

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Central Venous Stenosis after Hemodialysis: Case Reports and Relationships to Catheters and Cardiac Implantable Devices

Cardiorenal Medicine ◽

10.1159/000496065 ◽

2019 ◽

Vol 9 (3) ◽

pp. 135-144 ◽

Cited By ~ 1

Author(s):

Mario Pacilio ◽

Silvio Borrelli ◽

Giuseppe Conte ◽

Roberto Minutolo ◽

Antonino Musumeci ◽

...

Keyword(s):

Case Reports ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava ◽

Venous Catheter ◽

Transluminal Angioplasty ◽

Central Venous ◽

Central Venous Stenosis ◽

Cardiac Devices ◽

Venous Stenosis

The appropriate vascular access for hemodialysis in patients with cardiac implantable electronic devices (CIED) is undefined. We describe two cases of end-stage renal disease patients with CIED and tunneled central venous catheter (CVC) who developed venous cava stenosis: (1) a 70-year-old man with sinus node disease and pacemaker in 2013, CVC, and a Brescia-Cimino forearm fistula in 2015; (2) a 75-year-old woman with previous ventricular arrhythmia with implanted defibrillator in 2014 and CVC in 2016. In either case, after about 1 year from CVC insertion, patients developed superior vena cava (SVC) syndrome due to stenosis diagnosed by axial computerized tomography. In case 1, the patient was not treated by angioplasty of SVC and removed CVC with partial resolving of symptoms. In case 2, a percutaneous transluminal angioplasty with placement of a new CVC was required. To analyze these reports in the context of available literature, we systematically reviewed studies that have analyzed the presence of central venous stenosis associated with the simultaneous presence of CIED and CVC. Five studies were found; two indicated an increased incidence of central venous stenosis, while three did not find any association. While more studies are definitely needed, we suggest that these patients may benefit from epicardial cardiac devices and the insertion of devices directly into the ventriculus. If the new devices are unavailable or contraindicated, peritoneal dialysis or intensive conservative treatment in older patients may be proposed as alternative options.

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Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis

The Journal of Vascular Access ◽

10.1177/1129729820917255 ◽

2020 ◽

Vol 21 (6) ◽

pp. 1023-1028

Author(s):

Ana Carolina Figueiredo ◽

Filipe Mira ◽

Luís Rodrigues ◽

Emanuel Ferreira ◽

Nuno Oliveira ◽

...

Keyword(s):

Vascular Access ◽

Venous Catheter ◽

Iliac Vein ◽

Lower Limbs ◽

Implantation Technique ◽

Central Venous ◽

Vein Thrombosis ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Outflow Graft

Introduction: Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant. Patients and methods: Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment. Results: Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months. Conclusion: Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.

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Resolved Cerebral Venous Hypertension after Angioplasty of Central Venous Stenosis in a Hemodialysis Patient: A Case Report

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2021.0032 ◽

2021 ◽

Vol 82 ◽

Author(s):

Heemin Kang ◽

Sung-Tae Park

Keyword(s):

Case Report ◽

Hemodialysis Patient ◽

Venous Hypertension ◽

Central Venous ◽

Central Venous Stenosis ◽

Venous Stenosis

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Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

BMJ Case Reports ◽

10.1136/bcr-2019-229398 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229398

Author(s):

Lloyd Steele ◽

David Flowers ◽

Simon Coles ◽

Paul Gibbs

Keyword(s):

Cardiac Resynchronisation Therapy ◽

Venous Hypertension ◽

Ptfe Graft ◽

Pulsatile Tinnitus ◽

Central Venous ◽

Upper Arm ◽

Cardiac Device ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Arm Swelling

A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.

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Factors Related to the Success of Endovascular Therapy with Plain Old Balloon Angioplasty of Central Vein Stenosis in Haemodialysis Patients

Journal of Indonesian Society for Vascular and Endovascular Surgery ◽

10.36864/jinasvs.2020.1.002 ◽

2019 ◽

Vol 1 (1) ◽

pp. 6-9

Author(s):

Akhmadu Muradi ◽

Donie Firdhianto ◽

Aria Kekalih

Keyword(s):

Endovascular Therapy ◽

Balloon Angioplasty ◽

Catheter Placement ◽

Central Vein ◽

Dialysis Access ◽

Central Venous ◽

Hemodialysis Catheter ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Plain Old Balloon Angioplasty

Introduction: Central venous stenosis (CVS) or occlusion is a severe complication in hemodialysis patients, which significantly decreases the patency of all vascular dialysis access components, including arteries and branches, AV anastomosis, peripheral veins, and central veins. The main etiology of CVS is mostly secondary to the placement of temporary or permanent dialysis catheters in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy for central venous stenosis is conventional balloon angioplasty. Method: This is a retrospective study using medical records from June 2013 to August 2018. Patients who underwent plain old balloon angioplasty (POBA) procedures in the CVS condition due to the installation of hemodialysis catheter access were included in this study. The analysis was performed to assess the characteristics and data distribution of each variable. Results: Significant factors related to the success of endovascular procedure in patients with central venous stenosis with POBA were the onset of clinical symptoms (<3 months; p <0.001), duration of catheter placement (<2.5 months; p <0.001), history of previous catheter placement (no more than once, p <0.001), initial stenosis (<80; p <0.001), and diameter of POBA (≥ 10 mm; p <0.001). Conclusion: Some factors influenced the success of the POBA procedure for overcoming CVS. The need to understanding the use of hemodialysis catheter access according to the guideline is important. Keywords: central venous stenosis, endovascular therapy, plain old balloon angioplasty

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The role of angioplasty in haemodialysis patients with symptomatic venous hypertension owing to central venous stenosis

The Egyptian Journal of Surgery ◽

10.4103/ejs.ejs_86_18 ◽

2019 ◽

Vol 38 (1) ◽

pp. 19

Author(s):

MahmoudS Eldesouky ◽

HeshamA Greda ◽

MohammedA Elbalshy

Keyword(s):

Venous Hypertension ◽

Central Venous ◽

Central Venous Stenosis ◽

Venous Stenosis

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

Vascular ◽

10.1177/17085381211068996 ◽

2022 ◽

pp. 170853812110689

Author(s):

Kristin Schafer ◽

Eric Goldschmidt ◽

Andrew Seiwert

Keyword(s):

Upper Extremity ◽

Venous Hypertension ◽

Complete Relief ◽

Surgical Removal ◽

Central Venous ◽

Outflow Obstruction ◽

Venous Outflow ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Venous Outflow Obstruction

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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