Di Iorio B R, Mondillo F, Bortone S, Nargi P, Capozzi M, Spagnuolo T, Cucciniello E, Bellizzi V
Nephrology and Dialysis Unit, A. Landolfi Hospital, Solofra, Avellino, Italy.
J Vasc Access. 2006 Apr-Jun;7(2):60-5. doi: 10.1177/112972980600700204.
The ideal dialysis access ensures adequate blood flow for dialysis, has a long life, and is associated with a low complication rate. Although no current type of access fulfills all these criteria, the native arteriovenous fistula (AVF) is close to doing so. Unfortunately, various kinds of vascular access (VA) are becoming more and more necessary to enable hemodialysis (HD). The central venous catheter (CVC), which is associated with higher morbidity and mortality, could be the only viable option to maintain permanent VA. We report an unusual complication in a patient, a 74-year-old female, who had been undergoing HD via a CVC for 14 yrs. A polyurethane CVC with a double lumen was inserted into the right internal jugular vein because an AVF was not feasible, and a polytetrafluoroethylene (PTFE) prosthesis was obstructed. In 2003, the CVC was removed due to stenosis and occlusion of the superior vena cava. A new CVC, also made of polyurethane and with a double lumen, was inserted into the left femoral vein. In January 2005, the patient reported a small rupture of about 3-4 mm located under the cuff of the CVC. For this reason, the left femoral vein had to be used, replacing the Optiflow one with a 40-cm long Tesio CVC, and the second catheter was inserted into the right femoral artery by conventional surgery. After 10 months, the patient returned once more, after the CVC in the left femoral vein had been removed because of malfunction and that the at-tempts to cannulate the same vein again had failed. Currently, two 70-cm long Tesio catheters implanted in the right femoral vein (whose tips almost reach the diaphragm) are used for dialysis sessions. The number of CVC implants has progressively increased amongst HD patients who are elderly, diabetic or who have been on long-term HD. The patient described in this case report is currently using a 70-cm long double Tesio catheter (single Tesio CVC in SPI silicon) placed in the right femoral vein. She has resumed therapy with dicumarol anticoagulants, maintaining INR within the 2.5-3.5 range. In conclusion, both the increase in the use of venous catheters for HD and in the survival of dialysis patients contribute towards the observation of rare complications associated with CVC use.
理想的透析通路应确保有足够的血流量用于透析，使用寿命长，且并发症发生率低。尽管目前没有一种通路能满足所有这些标准，但自体动静脉内瘘（AVF）已接近能做到这一点。不幸的是，为了进行血液透析（HD），越来越需要各种血管通路（VA）。中心静脉导管（CVC）与较高的发病率和死亡率相关，可能是维持永久性VA的唯一可行选择。我们报告了一名74岁女性患者的罕见并发症，该患者通过CVC进行HD已达14年。由于AVF不可行且聚四氟乙烯（PTFE）假体阻塞，将一根双腔聚氨酯CVC插入右颈内静脉。2003年，由于上腔静脉狭窄和闭塞，移除了该CVC。一根同样由聚氨酯制成的双腔新CVC被插入左股静脉。2005年1月，患者报告CVC袖带下方出现约3 - 4毫米的小破裂。因此，不得不使用左股静脉，用一根40厘米长的特西奥CVC替换Optiflow CVC，并通过常规手术将第二根导管插入右股动脉。10个月后，患者再次前来，此前左股静脉的CVC因故障被移除，且再次尝试插管该静脉失败。目前，两根70厘米长的特西奥导管植入右股静脉（其尖端几乎到达膈肌）用于透析治疗。在老年、糖尿病或长期进行HD的HD患者中，CVC植入的数量逐渐增加。本病例报告中描述的患者目前使用一根70厘米长的双特西奥导管（SPI硅树脂中的单特西奥CVC）置于右股静脉。她已恢复使用双香豆素抗凝剂进行治疗，将国际标准化比值（INR）维持在2.5 - 3.5范围内。总之，HD中静脉导管使用的增加以及透析患者生存期的延长，都促使人们观察到与CVC使用相关的罕见并发症。
