Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Division of Nephrology, Bosei Hospital, Saitama, Japan.
J Vasc Access. 2021 May;22(3):488-491. doi: 10.1177/1129729820926081. Epub 2020 Jun 2.
Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.
血管通路是血液透析所必需的，在某些情况下，难以建立动静脉瘘或动静脉移植物时，可能需要使用永久性血液透析导管。然而，可能会发生严重的导管相关并发症，如中心静脉狭窄或血栓形成。本文报告了一例狼疮性肾炎患者使用隧道式血液透析导管进行血液透析时发生完全头臂静脉阻塞的病例。一名 64 岁患者因引入血液透析时动静脉瘘失败而接受抗凝治疗，在右侧颈内静脉内置入隧道式血液透析导管。然而，由于导管相关血流感染，导管被取出。在给予抗生素后，在右臂肱动脉和腋静脉之间植入了动静脉移植物。令人惊讶的是，在动静脉移植物创建后 3 天，观察到右侧头臂静脉完全阻塞和动静脉移植物失败。总之，我们报告了一例狼疮性肾炎血液透析患者使用隧道式血液透析导管相关的右侧头臂静脉完全阻塞的病例。当使用隧道式血液透析导管时，临床医生应该意识到这种潜在的并发症，并在隧道式血液透析导管长期留置之前，考虑下一种血管通路类型。
