Haller Claude, Déglise Sébastien, Saucy Francois, Mathieu Claudine, Haesler Erik, Doenz Francesco, Corpataux Jean Marc, Qanadli Salah Dine
Unit of Thoracic and Vascular Surgery, CHUV-University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland.
Cardiovasc Intervent Radiol. 2009 Jul;32(4):695-702. doi: 10.1007/s00270-009-9598-3. Epub 2009 May 16.
A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42-80 years), with central venous stenosis or occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography. Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement. Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8-48 months). Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement, respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion, for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates. This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein.
描述了一种用于中心胸段静脉狭窄或闭塞患者的血液透析导管置入方法，并分析了初步结果。回顾了12例平均年龄63.2岁（42 - 80岁）、患有中心静脉狭窄或闭塞且需要血液透析导管的患者。所有病变均经螺旋CT或静脉造影证实。5例患者有狭窄，7例患者被诊断为胸段中心静脉闭塞。所有患者均无症状，无上腔静脉综合征迹象。在经皮经狭窄导管插入术或闭塞时基于导丝的再通术后，进行球囊扩张，并在必要时在导管置入前放置支架。技术成功率为92%。3例患者仅进行了血管成形术，9例患者进行了血管成形术并放置了支架。透析导管通过所有再通的通路成功插入。术后未发生即刻并发症，也没有患者出现上腔静脉综合征。平均随访时间为21.8个月（范围8 - 48个月）。3例患者出现导管功能障碍并形成纤维蛋白鞘（分别在导管置入后7、11和12个月）。2例通过经皮血管内方法成功处理，1例导管被拔除。总之，对于患有中心静脉狭窄或闭塞且需要血液透析导管的患者，在血管内再通后可立即可靠地实现导管插入，技术成功率和长期成功率均可接受。该技术应被视为通过通畅静脉置入新的血液透析导管的替代方法。
