Is there an Association between Central Vein Stenosis and Line Infection in Patients with Tunnelled Central Venous Catheters (TCVCs)?

Abstract Background and Aims comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of central veins stenosis in patients on hemodialysis. Method A retrospective study included 62 patients with confirmed stenosis of the central veins: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. In 39 patients, stents are not used; isolated balloon angioplasty (BA) was performed. In 23 patients we used bare metal stents. Results Functional primary patency (the time interval between the start of AVF using and the first endovascular intervention) did not differ in the groups – fig. 1A; HR 1.142 [95% CI 0.6875; 1.897], p = 0.5994. The use of stents leads to increase primary patency (the time interval between the first and second endovascular interventions) – fig. 1B; HR 2.064 [95% CI 1.252; 3.404], p = 0.0017. The use of stents allows to increase the functional secondary patency (total duration of use of the AVF) – fig 1C; HR 2.099 [95% CI 1.272; 3.463], p = 0.0016. Secondary patency (the time interval between the first endovascular intervention and the complete cessation of the use of AVF) was higher after BA with stenting: HR 2.03 [95% CI 1.232; 3.347], p = 0.0021; fig 1D. The use of stents allows to increase functional primary assisted patency (non-occlusive period from the start of AVF use) – fig. 1E and primary assisted patency (non-occlusive period from the first surgical intervention) – fig 1F: HR 1.936 [95% CI 1.175; 3.188], p= 0.0053 and HR 2.0 [95% CI 1.213; 3.295], p = 0.0042. The need for open reconstructive interventions after the first BA or BA with stenting was the same 0.374 [95% CI 0.24; 0.556] and 0.45 [95% CI 0.291; 0.664] per 10 patient-months, incidence rate ratio (IRR)= 0.831 [95% CI 0.471; 1.464] р=0.521. The need for endovascular interventions did not differ between isolated BA and BA with stenting 1.137 [95% CI 0.8913; 1.43] and 0.827 [95% CI 0.606; 1.104] per 10 patient-months, IRR=1.374 [95% CI 0.952; 1.999] p=0.09. Total need for surgical interventions (open + endovascular) also did not differ: 1.511 [95% CI 1.225; 1.843] and 1.277 [95% CI 0.997; 1.611] per 10 patient-months, IRR 1.183 [95% CI 0.872; 1.612] p=0.2822. We found a strong negative correlation between functional primary patency and primary patency (r = -0.627; p <0.0001) – fig. 2, as well as a between functional primary patency and secondary patency in patients after isolated BA (= -0.53; p = 0.0005, respectively), but not after stenting (r = -0.351; p = 0.101 and r = -0.304; p = 0.159, respectively). In a case of isolated BA, the success of the first intervention largely determines the secondary patency, which is expressed in a strong, statistically significant positive correlation of primary patency and secondary patency. In a case of BA with stenting, the correlation between these estimates is also statistically significant, but significantly lower. Conclusion 1. The results of balloon angioplasty without stenting are significantly influenced by the duration of the period between the start of AVF use and the manifestation of central vein stenosis. 2. The use of stents can slightly improve the results of endovascular interventions in central vein stenosis, regardless the its time of development. 3. The use of stents leads to a moderate increase in the median patency of AVF and a significant increase in the proportion of patients with functional AVF in the late postoperative period. 4. The use of stents does not reduce the need for surgical interventions

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Central vein stenosis masquerading as venous thrombosis

BMJ Case Reports ◽

10.1136/bcr-2014-203690 ◽

2014 ◽

Vol 2014 (mar24 1) ◽

pp. bcr2014203690-bcr2014203690 ◽

Cited By ~ 1

Author(s):

N. Vellalacheruvu ◽

N. Monigari ◽

T. Devasia ◽

H. Kareem

Keyword(s):

Venous Thrombosis ◽

Central Vein ◽

Vein Stenosis ◽

Central Vein Stenosis

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P1319AMBIGUOUS RESULTS OF CENTRAL VEIN STENOSIS ENDOVASCULAR TREATMENT IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1319 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Aleksei Zulkarnaev ◽

Zurab Kardanakhishvili ◽

Boris Baykov

Keyword(s):

Blood Flow ◽

Median Survival ◽

Balloon Angioplasty ◽

Primary Patency ◽

Main Group ◽

Control Group ◽

Time Interval ◽

Central Vein ◽

Vein Stenosis ◽

Central Vein Stenosis

Abstract Background and Aims Balloon angioplasty (BA) without the use of stents has unsatisfactory results, which may cast doubt on its expediency. At the same time, BA is a very expensive treatment method. We conducted a comprehensive comparative analysis of the native arteriovenous fistula (AVF) patency rates in hemodialysis patients with central venous stenosis (CVS) after endovascular BA and «open» palliative surgery. Method A retrospective study included 80 patients with confirmed central vein stenosis: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. The main group included 39 patients who underwent percutaneous balloon angioplasty. The control group included 41 patients who did not have balloon angioplasty for various reasons. In this patients we performed only «open» palliative interventions: thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow reduction. Results Functional primary patency (the time interval between the start of AVF using and the first intervention) did not differ: groups were comparable in time of stenosis manifestation (fig. 1A). Primary patency (the time interval between the first and second interventions) after BA was statistically significantly better than in the main group (fig. 1B), but difference was minimal: median survival in the study group of 8 months [95% CI 6; 10] vs. - 6 months [95% CI 4.9; 7.1]. There was the strong negative correlation between the primary patency and functional primary patency in the main group (r = –0.627 [95%CI –0.787; –0.388], p <0.0001) but not in the control group (r = 0.049 [95%CI –0.262; –0.351], p = 0.7599). Thus, the later manifestation of CVS related with lower effectiveness of BA. The functional secondary patency (total duration of AVF use) in the main group was significantly better: median survival was 47 months [95% CI 40.9; 53.1] vs. 34 months [95% CI 29.8; 38.2] as well as secondary patency (the time interval between the first intervention and the complete cessation of AVF use): median survival was 16 months [95% CI 12.5; 19.5] vs. 7 months [95% CI 4.9; 9.1] (fig. 1 C and D). The occlusion-free period from the moment of starting the AVF use (functional primary assisted patency – fig. 1E) was higher in the main group, but difference was minimal: median survival was 39 months [95% CI 36.5; 41.5] vs. 32 months [95% CI 27.5; 36.5], as well as occlusion-free period from the moment of the first surgical intervention (primary assisted patency – fig. 1F) median survival was 9 months [95% CI 7; 11], in the control group - 7 months [95% CI 5.6; 8.4]. The need for open interventions was lower in the main group: 0.374 [95% CI 0.24; 0.556] and 2.451 [95% CI 1.1963; 3.023] per 10 patient-months, incidence rate ratio (IRR)= 0.153 [95% CI 0.095; 0.237], р<0.0001; as well as overall need for interventions: 1.511 [95% CI 1.225; 1.843] and 2.451 [95% CI 1.963; 3.023] per 10 patient-months, IRR 0.617 [95% CI 0.461; 0.825] p=0.0011. The value of AVF volume blood flow had a strong negative correlation with the primary patency in both groups (r = –0.529, p =0.0027; r = –0.419, p =0.0101). Conclusion 1. Central vein stenosis is inevitably leads to loss of vascular access on the ipsilateral side. 2. Balloon angioplasty allows to extend the period of AVF use but it is not a radical treatment method of CVS. 3. The results of balloon angioplasty are significantly affected by the length of the period from the start of AVF use to the CVS manifestation. 4. Multiple repeated BA are apparently justified in patients for whom the possibility of creating a new vascular access is doubtful. 4. The AVF volume blood flow is an important factor determining the severity of CVS clinical manifestations and the need for repeated surgical interventions.

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AS-287 Is Endovascular Therapy of Asymptomatic Central Vein Stenosis Needed?

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.01.131 ◽

2012 ◽

Vol 109 (7) ◽

pp. S59

Author(s):

Shih-Yun Pu ◽

Pei-Shan Lin ◽

Chih-Chung Yang ◽

Lin Lin ◽

Mu-Yang Hsieh ◽

...

Keyword(s):

Endovascular Therapy ◽

Central Vein ◽

Vein Stenosis ◽

Central Vein Stenosis

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Endovascular interventions for central vein stenosis

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2015.10.005 ◽

2015 ◽

Vol 34 (4) ◽

pp. 228-232 ◽

Cited By ~ 15

Author(s):

Anil K. Agarwal

Keyword(s):

Central Vein ◽

Endovascular Interventions ◽

Vein Stenosis ◽

Central Vein Stenosis

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Bilateral brachiocephalic vein stenosis in a chronic hemodialysis patient with well-functioning arteriovenous fistula – A rare entity

Polish Journal of Surgery ◽

10.5604/01.3001.0014.1734 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

MAJ GEN SINGH ◽

VINOD KUMAR

Keyword(s):

Arteriovenous Fistula ◽

Young Female ◽

Chronic Hemodialysis ◽

Brachiocephalic Vein ◽

Central Vein ◽

Chronic Hemodialysis Patient ◽

Stage Renal Disease ◽

End Stage ◽

Vein Stenosis ◽

Central Vein Stenosis

Introduction: Central vein stenosis has been reported in patients of end stage renal disease with subclavian vein being more commonly affected than brachiocephalic vein. Case report: We present a case of young female with bilateral brachiocephalic vein obstruction following arteriovenous fistula creation for hemodialysis.

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