Department of Cardiology and Nephrology, 962nd Hospital of the PLA Joint Logistics Support Force, Harbin, China.
Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
BMC Nephrol. 2024 Aug 24;25(1):271. doi: 10.1186/s12882-024-03718-4.
Central venous occlusion (CVO) is difficult to treat with percutaneous transluminal angioplasty because the guidewire cannot pass through the occluded segments. In this study, we devised a new method for establishing an extra-anatomic bypass between the right subclavian vein and the superior vena cava via a covered stent to treat whole-segment occlusion of the right brachiocephalic vein (BCV) with calcification.
We present the case of a 58-year-old female patient who complained of right arm swelling present for 1.5 years. Twelve years prior, the patient began hemodialysis because chronic glomerulonephritis had progressed to end-stage renal disease. During the first 3 years, a right internal jugular vein (IJV)-tunneled cuffed catheter was used as the dialysis access, and the catheter was replaced once. A left arteriovenous fistula (AVF) was subsequently established. Owing to occlusion of the left AVF, a new fistula was established on the right upper extremity 1.5 years prior to this visit. Angiography of the right upper extremity revealed complete occlusion of the right BCV and IJV with calcification. Because of the failure to pass the guidewire across the lesion, we established an extra-anatomic bypass between the right subclavian vein and the superior vena cava with a covered stent. Angiography confirmed the patency of whole vascular access system. After 3 months of follow-up, the patient's AVF function and the bypass patency were satisfactory.
As a new alternative for the treatment of long, angled CVO with or without calcification, a covered stent can be used to establish an extravascular bypass between central veins.
经皮腔内血管成形术治疗中心静脉阻塞（CVO）较为困难，因为导丝无法穿过闭塞段。在本研究中，我们设计了一种新方法，通过覆膜支架在右锁骨下静脉和上腔静脉之间建立一种额外的解剖旁路，以治疗伴有钙化的右头臂静脉（BCV）全段闭塞。
我们报告了一位 58 岁女性患者的病例，她因右臂肿胀 1.5 年就诊。12 年前，患者因慢性肾小球肾炎进展为终末期肾病开始接受血液透析。前 3 年，使用右颈内静脉（IJV）隧道带套囊导管作为透析通路，导管更换了一次。随后建立了左动静脉瘘（AVF）。由于左 AVF 闭塞，在本次就诊前 1.5 年，在右上肢建立了新的瘘管。右上肢血管造影显示右 BCV 和 IJV 完全闭塞伴钙化。由于导丝无法穿过病变部位，我们使用覆膜支架在右锁骨下静脉和上腔静脉之间建立了额外的解剖旁路。血管造影证实整个血管通路系统通畅。随访 3 个月后，患者的 AVF 功能和旁路通畅情况满意。
作为治疗伴有或不伴有钙化的长段、成角 CVO 的一种新选择，覆膜支架可用于建立中心静脉之间的血管外旁路。
