Purpose: New device that is available for central venous catheterization makes various vascular access possible. The long-term side effect of central catheterization, however, can not be ignored. Among them, central venous stenosis or obstruction associated with ipsilateral limb swelling is one of a serious problem. To evaluate the cause of central venous obstruction, clinical manifestation and result of various treatment modalities, 28 patients with limb swelling caused by central venous catheterization were analyzed.
Method: Twenty-four patients of hemodialysis were grouped 1, and 4 patients of chemotherapy were grouped 2. The number of catheterization per patient and duration of indwelling catheter were 3.5 times and 106 days in group 1 but 1.3 times and 45 days in group 2.
Result: More than 60% of central venous obstruction developed at left side and more frequently at subclavian vein. Symptom, such as arm swelling, confined to ipsilateral limb in all group 2 but in group 1, that swelling extended to ipsilateral face, neck and trunk in 9 patients (37.5%). These extended symptom is developed more in pateints who had ipsilateral antecubital arteriovenous fistula and even more patient with PTFE fistura. Among 20 patients of balloon in angioplasty, 7 developed recurred symptom within 6 months but all 4 of group 2 responded well to balloon angioplasty. One out of 3 stented patients and 2 out of 5 surgical bypass patients developed their original symptoms within 1 year so underwent ligation of fistula. But two patients with bypass graft survived with patent graft and functioning distal arteriovenous fistula until 38 and 52 months of follow up.
Conclusion: These results suggest that more central venous obstruction in hemodialysis patients are responsible for larger lumen of catheter, increase number of catheterization and duration of indwelling catheter. More extensive symptom in hemodialysis patient might be due to high inflow of distal arteriovenous fistula.
|