Vascular Health and Risk Management (Oct 2020)
Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease
Abstract
Qusai Aljarrah,1 Mohammed Allouh,2 Amer H Hallak,3 Shamikh E Alghezawi,3 Mamoon Al-Omari,4 Mwaffaq Elheis,4 Mooath Al-Jarrah,4 Sohail Bakkar,5 Abdelwahab J Aleshawi,6 Hussam Al-Jarrah,1 Khalid S Ibrahim,7 Jan Mohammed Al Shishani,8 Aws Almukhtar9 1Department of General & Vascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 17666, United Arab Emirates; 3Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 5Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan; 6Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 7Department of General & Cardiovascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 8Department of Vascular Surgery, King Hussein Medical Center, Amman 11733, Jordan; 9Department of Surgery and Cancer, Imperial College London, London SW7 2BU, UKCorrespondence: Qusai AljarrahDepartment of General & Vascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanTel +962 775593131Email [email protected] AllouhDepartment of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesTel +971 37 137 551Email [email protected]: Central venous lesions (CVLs) can adversely affect hemodialysis access maturation and maintenance, which in turn worsen patient morbidity and access circuit patency. In this study, we assessed several clinical variables, patient characteristics, and clinical consequences of symptomatic central vein stenosis and obstruction in patients who underwent renal replacement therapy in the form of hemodialysis.Patients and Methods: The medical records of all hemodialysis patients with clinically symptomatic CVLs who underwent digital subtraction angiography treatment at King Abdullah University Hospital between January 2017 and December 2019 were retrieved. Patient characteristics and the clinical and anatomical features of CVLs were analyzed retrospectively. Pearson’s chi-square tests of association were used to identify and assess relationships between patient characteristics and CVLs.Results: The study cohort comprised 66 patients with end-stage renal disease who developed symptomatic central vein stenosis. Of the 66 patients, 56.1% were men, and their mean age was approximately 52 years. Most (62.1%) of the patients were determined to have a history of central catheter insertion into the jugular vein. Hypertension was the most common comorbidity (78.8%, p< 0.001), followed by type 2 diabetes mellitus (47.0 %, p< 0.01). The incidence of stenosis was found to be significantly higher in the brachiocephalic vein than in other central veins (43.9%, p< 0.001). A repeated central catheter insertion in a patient was predictive of central venous occlusion (p< 0.05). Stenotic lesions were found to be associated with a significantly higher success rate than occlusive lesions (91.2%, p< 0.01).Conclusion: Multiple central venous catheters (CVCs) are found to be associated with occlusive CVLs and unfavorable recanalization outcomes. Multiple CVC should be avoided by creating a permanent vascular access in a timely fashion for patients with chronic kidney disease and by avoiding the ipsilateral insertion of CVC and AVF.Keywords: central venous lesions, brachiocephalic vein, central line catheterization, percutaneous transluminal angioplasty, fistula, hemodialysis
