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Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy: A
Yuliang Zhao1,2, Letian Yang3, Hongxia Mai1,2
1Division of Nephrology, Department of Internal Medicine.
Insights
Segmented sharp recanalization effectively treats long-segment central vein occlusion (CVO) in hemodialysis patients when conventional methods fail. This technique improved arteriovenous fistula flow and reduced swelling in a case study.
Area of Science:
- Vascular Surgery
- Interventional Nephrology
- Medical Imaging
Background:
- Central vein occlusion (CVO) is a frequent complication in hemodialysis patients.
- Percutaneous transluminal angioplasty is the standard treatment, but long-segment CVO remains challenging.
- Arteriovenous fistula (AVF) access is crucial for hemodialysis, and CVO can compromise its function.
Observation:
- A 73-year-old male hemodialysis patient presented with right arm and facial swelling.
- Digital subtraction angiography showed long-segment CVO from the right subclavian to innominate vein.
- Initial attempts at conventional guide wire crossing were unsuccessful.
Findings:
- Segmented sharp recanalization successfully traversed the entire long-segment, angled CVO.
- The procedure involved sequential crossing of the right subclavian and innominate veins.
- Balloon dilation and stent placement were performed after successful recanalization.
Implications:
- Segmented sharp recanalization offers a viable strategy for complex, long-segment CVO refractory to standard techniques.
- This approach can restore adequate blood flow to AVFs, improving hemodialysis efficiency.
- Successful treatment of CVO can alleviate symptoms like limb and facial edema, enhancing patient quality of life.
Introduction:
Among hemodialysis population, central vein occlusion (CVO) is a common complication. Percutaneous transluminal angioplasty has become the mainstay treatment these days. But the treatment of long-segment central venous occlusion remains difficult.
Patient Concerns:
We presented a 73-year-old man on maintenance hemodialysis complaining of swelling of the right arm and face for 20 days. The patient underwent maintenance hemodialysis via a right internal jugular vein catheter for first 2 months of dialysis while the initial right radiocephalic wrist arteriovenous fistula (AVF) blood flow had been unsatisfactory (below 180 mL/min) for 1 month.
Diagnosis:
Digital subtraction angiography revealed long-segment CVO extending from the right subclavian vein (SV) to the right innominate vein (IV), forming an obvious included angle at the right jugular angle.
Interventions:
Since conventional guide wire transversal failed, segmented sharp recanalization was performed by separate transversal of the obstructive right SV and right IV, therefore crossing the whole lesion segment by segment, followed by balloon dilation and stent placement.
Outcomes:
No procedure-related complication was recorded during or after the operation. After a follow-up period of 5 months, the patient's AVF maintained satisfactory in blood flow, while the edema in his ipsilateral limb and face also notably ameliorated.
Conclusion:
The segmented sharp recanalization is a practical strategy in treating angled long-segment CVO which is refractory to traditional guide wire transversal in hemodialysis patients.
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