Nguyen Daniel, Berman Scott S
Section of Vascular Surgery, The University of Arizona, Tucson, AZ.
J Vasc Surg Cases Innov Tech. 2025 Apr 28;11(4):101826. doi: 10.1016/j.jvscit.2025.101826. eCollection 2025 Aug.
Central venous occlusive disease (CVOD) is a challenging problem that frequently leads to the abandonment of an otherwise functional hemodialysis access. Prior central venous access, including tunneled dialysis catheters, are a common predisposing factor. CVOD is typically preceded by an interval period of stenosis and often amenable to simple balloon angioplasty. Occasionally, the use of aggressive techniques, including sharp recanalization and percutaneous thrombectomy, is necessary to restore patency. We describe a case of acute CVOD involving the left axillary, subclavian, and brachiocephalic vein outflow of an upper extremity arteriovenous fistula that required a multimodality approach, including sharp recanalization of a chronic occlusion, large-bore percutaneous thrombectomy system, balloon angioplasty, and stenting to restore patency and salvage the access site.
中心静脉闭塞性疾病（CVOD）是一个具有挑战性的问题，常常导致放弃原本功能良好的血液透析通路。既往的中心静脉置管，包括带隧道的透析导管，是常见的诱发因素。CVOD通常在一段狭窄期之前出现，且常常适合进行简单的球囊血管成形术。偶尔，需要采用包括锐性再通和经皮血栓切除术在内的积极技术来恢复通畅。我们描述了一例急性CVOD病例，累及上肢动静脉内瘘的左腋静脉、锁骨下静脉和头臂静脉流出道，该病例需要采用多模态方法，包括对慢性闭塞进行锐性再通、使用大口径经皮血栓切除系统、球囊血管成形术和支架置入术，以恢复通畅并挽救通路部位。
