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Murine Model of Central Venous Stenosis using Aortocaval Fistula with an Outflow Stenosis
Published on: July 11, 2019
Central vein stenosis in an Asian hemodialysis population
Stephen E Thwaites1, Peter A Robless
1Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
Insights
Central vein stenosis in hemodialysis patients is linked to frequent catheter use and access surgery. Reducing permanent catheter use may lower stenosis incidence.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Central vein stenosis is a common complication following thoracic vein instrumentation.
- It significantly impacts hemodialysis patients, potentially leading to access failure.
Purpose of the Study:
- To identify factors contributing to central vein stenosis in Asian hemodialysis patients.
- To evaluate the outcomes of interventions for central vein stenosis.
Main Methods:
- Retrospective analysis of 108 hemodialysis patients diagnosed with central vein stenosis (2003-2008).
- Comparison with controls with at least 2 years of hemodialysis without stenosis.
- Review of patient records for clinical presentation, comorbidities, and interventions.
Main Results:
- Arm swelling and failed catheter insertion were common presentations.
- Higher frequency of permanent hemodialysis catheter use (4x) was associated with stenosis development (p<0.001).
- Ischemic heart disease and arteriovenous fistula surgery were associated factors; sepsis, diabetes, and hypertension were not.
Conclusions:
- Central vein stenosis incidence correlates with increased hemodialysis catheter use and access surgeries.
- Strategies to minimize permanent catheter use are crucial for reducing central vein stenosis.
Objective And Background:
Central vein stenosis occurs commonly after instrumentation of the major thoracic veins. We aimed to investigate factors that contributed to this condition in an Asian hemodialysis population, and the results of intervention.
Patients And Methods:
Hemodialysis patients diagnosed with central vein stenosis between January 2003 and December 2008, were identified from the records of the National University Hospital, Singapore. Eligible controls had a minimum of 2 years of hemodialysis via an arteriovenous fistula and/or central venous catheter, without clinical or radiological evidence of central vein stenosis.
Results:
Central vein stenosis was diagnosed in 108 patients. The most common presenting features were arm swelling (32%) and failed hemodialysis catheter insertion (28%). The median frequency of permanent hemodialysis catheter insertion in those who subsequently developed venous stenosis (1.44 per patient per year) was 4 times that of controls (0.36 per patient per year; p<0.001). Ischemic heart disease (p = 0.03) and in certain patients, arteriovenous fistula surgery were associated with the development of central vein stenosis; whereas line sepsis, diabetes, and hypertension were not. Central vein angioplasty was attempted in 53 patients; the primary patency was 52% at 1 year.
Conclusion:
Central vein stenosis is associated with a higher frequency of hemodialysis catheter insertion and access surgery. Efforts to decrease permanent hemodialysis catheter use should reduce the incidence of central vein stenosis.
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