Coates G R, Clements J B, Yium J, Watlington J
Department of Surgery, Chattanooga Unit, University of Tennessee College of Medicine 37403.
South Med J. 1988 Mar;81(3):303-5. doi: 10.1097/00007611-198803000-00004.
The percutaneous subclavian vein hemodialysis catheter, which is widely used for vascular access in patients with renal failure, can give rise to several complications. Asymptomatic stenosis or occlusion of the subclavian vein due to these catheters can lead to painful arm edema if further dialysis accesses are constructed in the ipsilateral arm. This complication can lead to loss of valuable dialysis fistulas or grafts. We present six cases of this complication, along with management alternatives, which include conservative elevation, ligation of shunts, and surgical bypass of stenosed veins. Awareness of this complication should encourage early evaluation of patients who have had subclavian catheters and guide future placement of dialysis shunts. To preserve dialysis access sites, we advise an individualized approach to each patient who develops this painful arm edema.
经皮锁骨下静脉血液透析导管广泛应用于肾衰竭患者的血管通路建立，但可能引发多种并发症。这些导管导致的锁骨下静脉无症状狭窄或闭塞，如果在同侧手臂进一步建立透析通路，可能会引起手臂疼痛性水肿。这种并发症可能导致宝贵的透析内瘘或移植物丧失。我们报告6例该并发症病例及处理方法，包括保守性抬高、分流结扎和狭窄静脉的手术搭桥。认识到这种并发症应促使对有锁骨下导管的患者进行早期评估，并指导未来透析分流的放置。为保留透析通路部位，我们建议对每例发生这种手臂疼痛性水肿的患者采取个体化方法。
