Interventional Nephrology, The Ohio State University, Columbus, OH 43210, USA.
Am J Kidney Dis. 2013 Jun;61(6):1001-15. doi: 10.1053/j.ajkd.2012.10.024. Epub 2013 Jan 3.
Central vein stenosis (CVS) is commonly seen in patients receiving hemodialysis through an arteriovenous access, threatening the usability of arteriovenous access for dialysis. Subclavian and internal jugular catheters are prime reasons for the development of CVS, especially in the setting of long-term use of multiple catheters. CVS related to cardiac rhythm devices also is seen frequently. Idiopathic CVS can be encountered, although it is less common. Clinical features ultimately become sufficiently prominent to prompt angiographic evaluation. CVS should be evaluated carefully because management must be individualized. The primary method for treatment of CVS is endovascular intervention, including angioplasty and stent placement, whereas surgical options should be pursued in only refractory cases due to the invasiveness of the intervention. Early referral of patients for chronic kidney disease care; timely discussion of kidney replacement modality choices, including nonhemodialysis options such as peritoneal dialysis and kidney transplantation; placement of arteriovenous access prior to the onset of dialysis; and avoidance of catheters and other central vein instrumentation will prevent the development of CVS in most patients with kidney disease.
中心静脉狭窄（CVS）在接受动静脉通路血液透析的患者中较为常见，威胁着动静脉通路用于透析的可用性。锁骨下和颈内导管是 CVS 发展的主要原因，尤其是在长期使用多个导管的情况下。与心脏节律装置相关的 CVS 也很常见。尽管不太常见，但也可能会遇到特发性 CVS。最终，临床特征变得足够突出，从而促使进行血管造影评估。应仔细评估 CVS，因为必须对其进行个体化管理。CVS 的主要治疗方法是血管内介入治疗，包括血管成形术和支架置入术，而由于介入治疗的侵袭性，仅在难治性病例中才应考虑手术选择。早期将慢性肾脏病患者转介至接受慢性肾脏病治疗；及时讨论肾脏替代方式的选择，包括腹膜透析和肾移植等非血液透析选择；在开始透析前放置动静脉通路；避免使用导管和其他中心静脉器械，将预防大多数肾病患者 CVS 的发展。
