Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment
Section snippets
Patients and methods
This study was performed in two parts. Part 1 was a prospective study of 141 patients with functioning expanded polytetrafluorethylene upper-extremity bridge grafts in whom a screening ultrasound scan detected a graft or perigraft stenosis of >50%. These patients were then referred for confirmatory angiography. During the angiographic phase, the entire arterial inflow tract and venous outflow tract to the level of the right atrium was studied. This provides an estimate of the number of central
Part 1
Of 141 patients screened for the study, 110 (78%) had expanded polytetrafluorethylene grafts. Forty-one of the 110 (37.2%) patients with such grafts had a stenosis of ⩾50% identified by color flow duplex imaging and were referred for angiography. Of the 41 grafts subjected to both color flow duplex imaging and angiography, 25 were located in the left upper arm, five in the right upper arm, eight in the left forearm, two in the right forearm, and one was in the right thigh. Twenty-two of the
Discussion
Vascular access continues to be the Achilles' heel of hemodialysis13, 14, 15. Although graft thromboses and graft infection account for the majority of access-related complications, 16% of all the venous stenoses detected by angiography in patients with functioning expanded polytetrafluorethylene bridge grafts were within the central venous circulation[16]. The development of central venous hemodialysis catheters revolutionized the management of the acutely occluded hemodialysis graft by
References (24)
- et al.
Hemodialysis subclavian vein stenosis
Kidney International
(1988) - et al.
Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access
Annals of Vascular Surgery
(1994) - et al.
Prevention of hemodialysis fistula thrombosis: early detection of venous stenoses
Kidney International
(1989) Permanent vascular access: a nephrologists's view
American Journal of Kidney Disease
(1993)- et al.
Hospitalization in dialysis patients
Mayo Clinic Proceedings
(1984) Percutaneous transvenous angioplasty in the treatment of vascular access stenosis
Kidney International
(1992)- et al.
Angioplasty/thrombolytic treatment of failing and failed hemodialysis access sites: comparison with surgical treatment
Progress in Cardiovascular Disease
(1992) - et al.
Transluminal angioplasty versus surgical repair for stenosis of hemodialysis grafts: a randomized study
American Journal of Surgery
(1987) - et al.
Axillary and subclavian vein stenosis: percutaneous angioplasty
Radiology
(1988) - et al.
Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis
Transactions of the American Society of Artificial Internal Organs
(1976)