Aljarrah Qusai, Allouh Mohammed, Hallak Amer H, Alghezawi Shamikh E, Al-Omari Mamoon, Elheis Mwaffaq, Al-Jarrah Mooath, Bakkar Sohail, Aleshawi Abdelwahab J, Al-Jarrah Hussam, Ibrahim Khalid S, Al Shishani Jan Mohammed, Almukhtar Aws
Department of General & Vascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates.
Vasc Health Risk Manag. 2020 Oct 9;16:419-427. doi: 10.2147/VHRM.S273450. eCollection 2020.
Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis.
The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson's chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs.
The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, <0.001), followed by type 2 diabetes mellitus (47.0 %, <0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, <0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (<0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, <0.01).
Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.
中心静脉病变（CVL）会对血液透析通路的成熟和维持产生不利影响，进而加重患者的发病率并影响通路的通畅性。在本研究中，我们评估了接受血液透析形式的肾脏替代治疗的患者出现症状性中心静脉狭窄和阻塞的若干临床变量、患者特征及临床后果。
检索了2017年1月至2019年12月期间在阿卜杜拉国王大学医院接受数字减影血管造影治疗的所有有临床症状的CVL血液透析患者的病历。对患者特征以及CVL的临床和解剖特征进行了回顾性分析。采用Pearson卡方关联检验来识别和评估患者特征与CVL之间的关系。
研究队列包括66例出现症状性中心静脉狭窄的终末期肾病患者。在这66例患者中，56.1%为男性，平均年龄约为52岁。大多数患者（62.1%）被确定有颈内静脉中心静脉导管置入史。高血压是最常见的合并症（78.8%，<0.001），其次是2型糖尿病（47.0%，<0.01）。发现头臂静脉狭窄的发生率显著高于其他中心静脉（43.9%，<0.001）。患者重复进行中心静脉导管置入可预测中心静脉闭塞（<0.05）。发现狭窄性病变的成功率显著高于闭塞性病变（91.2%，<0.01）。
发现多条中心静脉导管（CVC）与闭塞性CVL及不良的再通结果相关。对于慢性肾脏病患者，应及时建立永久性血管通路，避免同侧置入CVC和动静脉内瘘，以避免使用多条CVC。
