Central venous stenosis among hemodialysis patients is often not associated with previous central venous catheters

Area of Science:

• Nephrology
• Vascular Surgery
• Radiology

Background:

• Central venous stenosis (CVS) is a common complication in chronic hemodialysis (HD) patients.
• Previous central venous catheterization is widely assumed to be the primary cause of CVS in HD patients.

Purpose of the Study:

• To evaluate the validity of the assumption that central venous catheterization is the most common cause of CVS in chronic hemodialysis patients.
• To investigate the characteristics of symptomatic CVS in HD patients, particularly those without a history of catheterization.

Main Methods:

• Retrospective review of clinical records from 2,856 chronic HD patients with vascular access failure over 5 years.
• Identification and examination of 26 patients with symptomatic CVS, including radiological findings.
• Diagnostic multidetector row computed tomography angiography used for detailed venous assessment.

Main Results:

• Only 7 out of 26 identified patients with symptomatic CVS had a history of internal jugular dialysis catheterization.
• In 7 of 19 patients without catheterization history, left innominate vein stenosis was attributed to extrinsic compression.
• Patients with extrinsic compression had a significantly shorter time from vascular access creation to referral (9.2 months) compared to others (35.5 months).

Conclusions:

• The assumption that central venous catheterization is the sole or most common cause of CVS in HD patients may be inaccurate.
• Central venous stenosis due to extrinsic compression is a notable finding in HD patients without a history of catheterization.
• Larger prospective studies are needed to confirm these findings in the broader chronic HD population with symptomatic CVS.