Premuzic Vedran, Smiljanic Ranko, Perkov Drazen, Gavranic Bruna Brunetta, Tomasevic Boris, Jelakovic Bojan
Department of Nephrology, Hypertension, Dialysis and Transplantation, Zagreb, Croatia.
Department of Diagnostic and Interventional Radiology, Zagreb, Croatia.
Ther Apher Dial. 2016 Aug;20(4):394-9. doi: 10.1111/1744-9987.12397. Epub 2016 Mar 28.
There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety-eight permanent dialysis catheters were placed (173 Tesio [87.4%] and 25 Hickman [12.6%]) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter-related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78-98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion-related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless, in four cases, the vessel obstruction and abnormality led to catheter insertion-related complications. When phlebography and CT venography was performed before the procedure in patients with prior permanent catheters and one or more CVS or thrombosis, early and late catheter-related complications were avoided by careful selection of the least injured vein and planning of procedure. When planning a permanent dialysis catheter placement in patients with prior multiple CVC, phlebography and CT venography may be diagnostic procedures of choice for avoidance of early catheter dysfunction and CVC placement complications.
中心静脉置管与中心静脉狭窄的发生之间存在相关性。轻微的胸骨后静脉病变很容易被漏诊。计算机断层扫描（CT）静脉造影是首选的诊断方法。本研究的目的是检查既往已置入永久性导管的患者在植入导管后的并发症，并评估在选择永久性置管部位之前所进行的现有诊断方法，以减少导管置入后可能出现的并发症。对2011年10月至2015年2月间本科室永久性中心静脉导管（CVC）置入的并发症进行了分析。我们植入了泰西奥双导管系统和希克曼双腔导管。所有既往有永久性透析导管的患者均接受彩色多普勒检查，而疑似中心静脉狭窄（CVS）或血栓形成的患者在导管置入前接受静脉造影或CT静脉造影检查。163例患者共置入198根永久性透析导管（173根泰西奥导管[87.4%]和25根希克曼导管[12.6%]）。有125例患者（76.7%）既往有临时导管，其中61例（48.8%）患者有不止一根既往永久性导管（人均1.92根导管）。61例患者中有4例（6.5%）出现导管相关并发症，这些患者在置管前未进行静脉造影和CT静脉造影检查。30例（24.0%）疑似CVS/血栓形成且透析龄为76.23个月（52.78 - 98.28）的患者接受了静脉造影和CT静脉造影检查。在检测既往有永久性导管置入的患者的CVS/血栓形成方面，静脉造影和CT静脉造影比彩色多普勒更敏感（P < 0.001）。自从在导管置入前引入这种诊断算法后，未出现与导管插入相关的并发症或功能障碍（P < 0.001）。我们对所有既往有永久性导管的患者所进行的操作均遵循初步的彩色多普勒诊断。然而，有4例患者，血管阻塞和异常导致了与导管插入相关的并发症。当对既往有永久性导管且有一处或多处CVS或血栓形成的患者在操作前进行静脉造影和CT静脉造影检查时，通过仔细选择损伤最小的静脉并规划操作，可以避免早期和晚期导管相关并发症。当为既往有多个CVC的患者计划置入永久性透析导管时，静脉造影和CT静脉造影可能是避免早期导管功能障碍和CVC置入并发症的首选诊断方法。
