Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease

Abstract

Purpose

Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis.

Patients and Methods

The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson’s chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs.

Results

The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p<0.001), followed by type 2 diabetes mellitus (47.0 %, p<0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p<0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p<0.01).

Conclusion

Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.

Keywords:

• central venous lesions
• brachiocephalic vein
• central line catheterization
• percutaneous transluminal angioplasty
• fistula
• hemodialysis

Abbreviations

CVL, central venous lesion; CVC, central venous catheter; SVC, superior vena cava; SCV, subclavian vein; BCV, brachiocephalic vein; IJV, internal jugular vein; AVF, arteriovenous fistula; AVG, arteriovenous graft.

Consent for Publication

Not applicable. Data was used in aggregate with no personal identifiers.

Ethics Approval and Consent to Participate

This is a retrospective cohort study in which we utilized existing data from electronic medical records. Institutional Review Board approval was obtained from Jordan University of Science and Technology. For this type of study, formal and informed consent were waived since data was used in aggregate with no personal identifiers. The study was conducted with assurance of patient data confidentiality and in accordance to the Declaration of Helsinki and its later amendments for ethical research performance.

Disclosure

The authors declare that they have no competing interests.