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KMID : 0357019980140020330
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Journal of the Korean Vascular Surgery Society
1998 Volume.14 No. 2 p.330 ~ p.337
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Central Vein Occlusion in Hemodialysis Patients
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Cho Won-Hyun
Kim Hyoung-Tae
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Abstract
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As the increasing incidence of the double lumen catheterization (Quinton catheter) for temporal hemodialysis, central vein occlusion, a serious complication which can cause arteriovenous fistula failure, occurred more frequently. Severe arm edema, pain with venous hypertension and insufficient fistula function suggest central vein obstruction and this can be confirmed by color duplex sonography or venography. This kind of occlusion should be treated promptly because it is closely related with arteriovenous fistula function. Division and ligation of fistula is one option but to salvage the fistula
is more recommendable. For this purpose, thrombolysis, percutaneous transluminal balloon angioplasty (PTA) with or without stent insertion, direct surgical approach to the obstructed vein, surgical bypass using autogenous vein or artificial graft are performed according to the site and degree of the obstruction. From January 1995 through December 1997, we experienced 9 cases of subclavian vein or innominated vein occlusion which were detected by angiogram in hemodialysis patients. Four cases were treated by
PTA with one case of thrombolysis at the same time. Two of them developed recurred symptoms at 3 and 6 months after PTA. The previous fistula were ligated and made a new basilic vein reposition arteriovenous fiatulas were made at opposite arm. Among the remaining 5 cases, surgical bypass was performed between internal jugular vein and subclavian vein in 2 cases, between axillary vein and opposite subclavian vein in 3 cases using 8 mm PTFE graft. One out of 5 surgical bypass group showed
recurred occlusion at 16 months and that patient died soon after that occlusion. Another one showed partial occlusion of bypassed graft but the symptoms were mild so we could continue hemodialysis without problems. The remained 3 cases were patent for more than 13 months of their follow up. In summary, to salvage the failed fistula by central vein obstruction, aggressive procedure such as surgical bypass using artificial graft to opposite central vein also be considered with PTA.
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KEYWORD
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Central vein obstruction, Double lumen catheterization, Failed fistula, Salvage procedure
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