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[Venous occlusions distant to the shunt as malfunction factors during hemodialysis]
K A Schumacher1, B Wallner, W Weidenmaier
1Röntgendiagnostische Abteilung der Radiologischen Klinik und Poliklinik des Klinikums der Universität Ulm.
Insights
Radiographic evaluation of 78 patients revealed that central venous stenosis significantly impacts haemodialysis vascular access. This condition can cause poor flow and recurrent thrombosis in arteriovenous fistulae or grafts.
Area of Science:
- Vascular Surgery
- Radiology
- Nephrology
Background:
- Haemodialysis vascular access dysfunction, primarily poor flow, affects numerous patients.
- Identifying the causes of such dysfunction is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the role of central venous stenosis in haemodialysis vascular access dysfunction.
- To evaluate the correlation between central venous stenosis and arteriovenous fistula/graft complications.
Main Methods:
- Systematic radiographic evaluation of 78 patients with haemodialysis vascular access dysfunction.
- Arteriography performed in all cases.
- Venous angiography conducted in cases of arteriovenous fistula or graft occlusion.
Main Results:
- 11 out of 78 patients (14%) exhibited occlusion or significant stenosis of proximal venous vessels (axillary/subclavian vein).
- Findings suggest a link between central venous stenosis and impaired shunt function.
- Central venous stenosis may contribute to recurrent thrombosis of vascular access.
Conclusions:
- Deterioration of central venous runoff is a significant factor in haemodialysis vascular access malfunction.
- Addressing central venous stenosis could mitigate shunt dysfunction and thrombosis.
- Radiographic evaluation is essential for diagnosing proximal venous stenosis impacting vascular access.
Abstract:
On 78 patients with dysfunction of haemodialysis vascular access (predominantly poor flow) systematic radiographic evaluation was performed. In all cases arteriography was carried out, followed by venous angiography in patients exhibiting occlusion of the arteriovenous fistula or the graft, respectively. In 11 cases (14%) occlusion or significant stenosis of far proximal venous vessels (axillary and/or subclavian vein) could be detected. It is suggested that consecutive deterioration of central venous runoff may induce or aggravate malfunctioning of the shunt and, moreover, may contribute to recurrent thrombosis of arteriovenous fistulae or grafts.