Zhao Yuliang, Yang Letian, Mai Hongxia, Yu Yang, Fu Ping, Cui Tianlei
Division of Nephrology, Department of Internal Medicine.
Kidney Research Laboratory, West China Hospital.
Medicine (Baltimore). 2019 Apr;98(16):e15208. doi: 10.1097/MD.0000000000015208.
Among hemodialysis population, central vein occlusion (CVO) is a common complication. Percutaneous transluminal angioplasty has become the mainstay treatment these days. But the treatment of long-segment central venous occlusion remains difficult.
We presented a 73-year-old man on maintenance hemodialysis complaining of swelling of the right arm and face for 20 days. The patient underwent maintenance hemodialysis via a right internal jugular vein catheter for first 2 months of dialysis while the initial right radiocephalic wrist arteriovenous fistula (AVF) blood flow had been unsatisfactory (below 180 mL/min) for 1 month.
Digital subtraction angiography revealed long-segment CVO extending from the right subclavian vein (SV) to the right innominate vein (IV), forming an obvious included angle at the right jugular angle.
Since conventional guide wire transversal failed, segmented sharp recanalization was performed by separate transversal of the obstructive right SV and right IV, therefore crossing the whole lesion segment by segment, followed by balloon dilation and stent placement.
No procedure-related complication was recorded during or after the operation. After a follow-up period of 5 months, the patient's AVF maintained satisfactory in blood flow, while the edema in his ipsilateral limb and face also notably ameliorated.
The segmented sharp recanalization is a practical strategy in treating angled long-segment CVO which is refractory to traditional guide wire transversal in hemodialysis patients.
在血液透析人群中，中心静脉闭塞（CVO）是一种常见的并发症。如今，经皮腔内血管成形术已成为主要的治疗方法。但长段中心静脉闭塞的治疗仍然困难。
我们报告了一名73岁维持性血液透析男性患者，其因右上肢和面部肿胀20天前来就诊。该患者在透析的前2个月通过右颈内静脉导管进行维持性血液透析，而最初的右桡动脉-头静脉腕部动静脉内瘘（AVF）血流量在1个月内一直不理想（低于180毫升/分钟）。
数字减影血管造影显示长段CVO从右锁骨下静脉（SV）延伸至右无名静脉（IV），在右颈静脉角处形成明显的夹角。
由于传统导丝穿刺失败，通过分别穿刺阻塞的右SV和右IV进行分段锐性再通，从而逐段穿过整个病变段，随后进行球囊扩张和支架置入。
手术期间及术后均未记录到与手术相关的并发症。经过5个月的随访，患者的AVF血流量维持良好，同时其同侧肢体和面部的水肿也明显改善。
分段锐性再通是治疗血液透析患者中对传统导丝穿刺难治的成角长段CVO的一种实用策略。
