Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access
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To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All 14 patients had had bilateral temporary subclavian vein dialysis catheters and failed upper extremity arteriovenous access. Seventeen lesions were treated in 14 patients including eight subclavian vein occlusions, six subclavian vein stenoses, two internal jugular vein stenoses, and one superior vena cava stenosis. Twenty-one procedures were performed including 17 percutaneous transluminal balloon angioplasties (PTAs) with stent placement in 13, two axillary to innominate vein bypasses, and two axillary to internal jugular vein bypasses. All patients had resolution of symptoms. Thirteen (76%) PTAs were initially successful but in four (24%) cases it was impossible to recanalize the vein. Eight (47%) PTAs provided functional hemodialysis access for 2 to 9 months, two (12%) restenosed at 3 and 10 months and were successfully redilated, two occluded at 2 and 4 months and were unable to be recanalized, and one failed immediately after a successful PTA. Four PTA failures were followed by venous bypass, which remained patent and provided functional access 7 to 13 months after surgery. Of nine stenotic venous lesions six (67%) were successfully dilated without restenosis, whereas of eight occluded veins only two (25%) were successfully treated without recurrence. Temporary central hemodialysis catheters produce a significant number of symptomatic central vein obstructions in patients with upper extremity arteriovenous access. PTA with stenting and venous bypass provides early success in most patients. Transcatheter therapy is less successful in treating complete venous occlusions when compared with stenotic lesions. All effort should focus on preventing this complication by avoiding the use of temporary subclavian vein hemodialysis catheters.
KeywordsInternal Jugular Vein Subclavian Vein Venous Bypass Hemodialysis Access Hemodialysis Catheter
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- 1.Lazarus JM, Huang WH, Lew NL, et al. Contribution of vascular access-related disease to morbidity of hemodialysis patients. In Henry ML, Ferguson RM, eds. Vascular Access for Hemodialysis — III. Chicago: Precept Press, 1993, pp 3–13.Google Scholar
- 2.Bassiouny HS, Krievins D, Glagov S, et al. Distal arteriovenous fistula inhibits experimental anastomotic intimal thickening. Surg Forum 1993;44:345–346.Google Scholar
- 11.Lund GB, Trerotola SO, Mitchell SE, et al. Central venous angioplasty: An exercise in futility in hemodialysis patients? Radiology 1993;189(P):198–199.Google Scholar
- 13.Sottiurai VS. Surgical management of brachio-axillary-subclavian vein thrombosis in hemodialysis patients. Presented at the Twenty-First World Congress of the International Society for Cardiovascular Surgery. Lisbon, Portugal: September 1993, pp 53–54.Google Scholar
- 14.Brown L, McLaren JT. Subclavian to jugular bypass for relief of intractable venous hypertension and salvage of hemodi-alysis access [Abst]. J Vasc Surg 1993;18:537.Google Scholar