Oguzkurt Levent, Tercan Fahri, Torun Dilek, Yildirim Tülin, Zümrütdal Aysegül, Kizilkilic Osman
Department of Radiology, Adana Medical Center, Baskent University, Dadaloglu Mah. 39 Sok No:6, Yuregir, Adana 01250, Turkey.
Eur J Radiol. 2004 Dec;52(3):293-9. doi: 10.1016/j.ejrad.2003.12.004.
To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters.
In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared.
The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P > 0.005). Of the eight patients (14%) with BCV stenosis, two had >50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein. Pericatheter sleeve formation was more frequent in women (P < 0.005). However, there were no statistical differences with respect to pericatheter sleeve formation, luminal filling defect and BCV stenosis when patients were grouped according to age, dwell time of the catheter, number of catheters inserted, and diameter of the SVC. Forty-two of the fifty-seven patients had had only right IJV (n =16) or right SCV (n = 26) catheters. There were no differences between these groups with respect to rates of pericatheter sleeve formation, thrombus formation, or BCV stenosis.
This study showed that even short-term catheters result in significantly high rates of pericatheter sleeve and thrombus formation which are two of the important causes of catheter malfunction. The IJV route is known to be much safer than the SCV route with respect to stenosis formation in the vein in which the catheter is inserted; however, the result showed no differences between the two routes with respect to frequencies of pericatheter sleeve formation, thrombus formation, and BCV stenosis. These findings remind us again that we should avoid unnecessary catheter insertion even for short-term in these chronically ill patients.
确定使用临时导管的血液透析患者中心静脉导管周围袖套形成、血栓形成及狭窄的发生率。
在这项前瞻性研究中，57例（40例男性，17例女性）使用临时透析导管的患者在拔管前通过回撤导管进行导管静脉造影。患者年龄范围为25 - 87岁（平均年龄51岁）。对静脉造影研究评估导管周围袖套形成、血栓形成以及头臂静脉（BCV）和上腔静脉（SVC）狭窄情况。仅在造影剂注入期间有足够充盈时才能评估颈内静脉（IJV）。在仅使用右侧IJV或仅右侧SCV导管的患者亚组中，比较这些导管对中心静脉的影响。
导管位置为右侧颈内静脉（IJV）26例，右侧锁骨下静脉（SCV）27例，左侧IJV 1例，左侧SCV 3例。32例患者（56%）仅使用一根临时导管，其余患者使用多根导管。导管平均留置时间为21天（范围7 - 59天）。静脉造影发现32例（56%）患者有导管周围袖套，16例患者（28%）有血栓形成。总共41例患者（72%）出现导管周围袖套和/或血栓形成。在32例既往未置管的患者中，19例（59%）导管周围有袖套，而在25例曾多次置管的患者中，只有13例（52%）有袖套（P > 0.005）。在8例（14%）有BCV狭窄的患者中，2例狭窄>50%。仅1例患者（2%）有轻度SVC狭窄。15例接受IJV诊断性静脉造影的患者中有3例（20%）静脉有严重狭窄。导管周围袖套形成在女性中更常见（P < 0.005）。然而，根据年龄、导管留置时间、置管数量和SVC直径对患者分组时，在导管周围袖套形成、管腔充盈缺损和BCV狭窄方面无统计学差异。57例患者中有42例仅使用右侧IJV（n = 16）或右侧SCV（n = 26）导管。这些组在导管周围袖套形成、血栓形成或BCV狭窄发生率方面无差异。
本研究表明，即使是短期导管也会导致导管周围袖套和血栓形成发生率显著升高，这是导管功能障碍的两个重要原因。就导管插入静脉的狭窄形成而言，已知IJV途径比SCV途径安全得多；然而，结果显示在导管周围袖套形成、血栓形成和BCV狭窄频率方面，两条途径无差异。这些发现再次提醒我们，即使对于这些慢性病患者进行短期置管，也应避免不必要的导管插入。
