Singh Vishal
Division of Nephrology, Department of Medicine, Command Hospital (AF), Bengaluru, Karnataka, India.
Indian J Nephrol. 2019 Jan-Feb;29(1):42-45. doi: 10.4103/ijn.IJN_14_18.
Hemodialysis remains the most common mode of renal replacement therapy in patients with end-stage renal disease (ESRD). It requires an appropriate vascular access. The vascular access while being the "lifeline" for patients on hemodialysis is also the "Achilles' heel" of the therapy. Although the gold standard for vascular access remains an arteriovenous fistula, in clinical practice situations often arise which mandates the use of central venous catheter (CVC). These CVCs while providing an immediate access for the performance of hemodialysis may be associated with various complications. These complications are usually minor requiring conservative management, but at times may be potentially life-endangering. We report a case where during the placement of the dialysis catheter, it inadvertently perforated the left innominate vein. A potential disaster was prevented by deploying a covered stent over the site. This alternative percutaneous approach when available can be a safe alternative to open surgical intervention and represents a paradigm shift in our approach.
血液透析仍然是终末期肾病（ESRD）患者最常见的肾脏替代治疗方式。它需要合适的血管通路。血管通路虽是血液透析患者的“生命线”，但也是该治疗的“阿喀琉斯之踵”。尽管血管通路的金标准仍是动静脉内瘘，但在临床实践中，常常会出现需要使用中心静脉导管（CVC）的情况。这些CVC在为血液透析提供即时通路的同时，可能会引发各种并发症。这些并发症通常较轻，只需保守处理，但有时可能会危及生命。我们报告一例在放置透析导管时意外穿破左无名静脉的病例。通过在该部位植入覆膜支架，避免了一场潜在的灾难。这种可供选择的经皮方法在可行时，可作为开放手术干预的安全替代方案，代表了我们治疗方法的一种范式转变。
