Division of Nephrology, University of Alabama at Birmingham, Alabama.
Division of Interventional Radiology, University of Alabama at Birmingham, Alabama.
Kidney360. 2021 Oct 21;3(1):99-102. doi: 10.34067/KID.0005202021. eCollection 2022 Jan 27.
Central vein stenosis (CVS) is a common complication in hemodialysis patients following tunneled central venous catheter (CVC) insertion. Little is known about its incidence, association with patient characteristics, or relationship with duration of CVC placement. We systematically evaluated central vein stenosis in hemodialysis patients receiving their first CVC exchange at a large medical center.
All new hemodialysis patients underwent an ultrasound before their internal jugular tunneled CVC placement, to exclude venous stenosis or thrombosis. After the initial CVC insertion, if the patients were referred for CVC exchange due to dysfunction, a catheterogram/venogram was performed to assess for hemodynamically significant (≥50%) central vein stenosis. During a 5-year period (January 2016 to January 2021), we quantified the incidence of CVS in patients undergoing CVC exchange. We also evaluated the association of central vein stenosis with patient demographics, comorbidities, and duration of CVC dependence before exchange.
During the study period, 273 patients underwent exchange of a tunneled internal jugular vein CVC preceded by a catheterogram/venogram. Hemodynamically significant CVS was observed in 36 patients (13%). CVS was not associated with patient age, sex, race, diabetes, hypertension, coronary artery disease, peripheral artery disease, or CVC laterality. However, the frequency of CVS was associated with the duration of CVC dependence (26% versus 11% for CVC duration ≥6 versus <6 months: odds ratio (95% CI), 3.17 (1.45 to 6.97), =0.003).
Among incident hemodialysis patients receiving their first tunneled internal jugular CVC exchange, the overall incidence of hemodynamically significant central vein stenosis was 13%. The likelihood of CVS was substantially greater in patients with at least 6 months of CVC dependence.
隧道式中心静脉导管（CVC）置入后，中心静脉狭窄（CVS）是血液透析患者的常见并发症。目前对于其发病率、与患者特征的相关性，以及与 CVC 留置时间的关系知之甚少。我们系统性地评估了在一家大型医疗中心接受首次 CVC 更换的血液透析患者的中心静脉狭窄情况。
所有新的血液透析患者在其颈内静脉隧道式 CVC 置入前均接受超声检查，以排除静脉狭窄或血栓形成。初次 CVC 置入后，如果患者因功能障碍而被转介进行 CVC 更换，则进行导管造影/静脉造影以评估是否存在血流动力学显著（≥50%）的中心静脉狭窄。在 5 年期间（2016 年 1 月至 2021 年 1 月），我们量化了接受 CVC 更换的患者 CVS 的发生率。我们还评估了中心静脉狭窄与患者人口统计学特征、合并症以及 CVC 依赖前的持续时间之间的关系。
在研究期间，273 名患者在进行隧道式颈内静脉 CVC 更换前进行了导管造影/静脉造影。36 名患者（13%）观察到血流动力学显著的 CVS。CVS 与患者年龄、性别、种族、糖尿病、高血压、冠状动脉疾病、外周动脉疾病或 CVC 侧位无关。然而，CVS 的频率与 CVC 依赖时间相关（CVC 依赖时间≥6 个月与<6 个月的 CVS 发生率分别为 26%和 11%：比值比（95%CI），3.17（1.45 至 6.97），=0.003）。
在接受首次隧道式颈内静脉 CVC 更换的新发血液透析患者中，血流动力学显著的中心静脉狭窄的总体发生率为 13%。CVC 依赖至少 6 个月的患者 CVS 的可能性明显更大。
