Upper extremity central venous obstruction in hemodialysis patients: Treatment with Wallstents

被引:92
作者
Vesely, TM [1 ]
Hovsepian, DM [1 ]
Pilgram, TK [1 ]
Coyne, DW [1 ]
Shenoy, S [1 ]
机构
[1] WASHINGTON UNIV,SCH MED,DEPT INTERNAL MED,NEPHROL SECT,ST LOUIS,MO 63110
关键词
dialysis; shunts; veins; grafts and prostheses; innominate; stenosis or obstruction; subclavian;
D O I
10.1148/radiology.204.2.9240518
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
PURPOSE: To determine the effectiveness of using Wallstents to treat subclavian or brachiocephalic venous obstruction after unsuccessful angioplasty, in patients undergoing hemodialysis. MATERIALS AND METHODS: Dialysis records, radiology reports, and procedural images of 20 hemodialysis patients who underwent Wallstent insertion into a subclavian (n = 11) or brachiocephalic (n = 9) vein were reviewed. Technical success and primary, assisted primary, and cumulative patency rates were calculated. RESULTS: Twenty-three Wallstents were inserted for stenosis (n = 18) or occlusion (n = 2). Technical success was 100%. Eight patients underwent 11 reinterventions to maintain patency of the Wallstent during the follow-up period. Patency rates of the Wallstent were (a) primary at I month, 3 months, 6 months, and I year: 90%, 67%, 42%, and 25%; (b) assisted primary at 3 months, 6 months, and 1 year: 88%, 62%, and 47%; and (c) cumulative at 3 months, 6 months, 1 year, and 2 years: 89%, 64%, 56%, and 22%. Considerable shortening of the stent occurred in five patients. One occurred immediately during the deployment procedure, but four were discovered weeks to months later. No other complications occurred. CONCLUSION: After suboptimal angioplasty, treatment of subclavian and brachiocephalic vein stenoses with a Wallstent can provide continued use of a hemodialysis access. Close clinical surveillance and multiple reinterventions are necessary to maintain Wallstent patency.
引用
收藏
页码:343 / 348
页数:6
相关论文
共 17 条
[1]   HEMODIALYSIS RELATED VENOUS STENOSES - TREATMENT WITH SELF-EXPANDING ENDOVASCULAR PROSTHESES [J].
ANTONUCCI, F ;
SALOMONOWITZ, E ;
STUCKMANN, G ;
STIEFEL, M ;
HUGENTOBLER, M ;
ZOLLIKOFER, CL .
EUROPEAN JOURNAL OF RADIOLOGY, 1992, 14 (03) :195-200
[2]   PERCUTANEOUS TRANSVENOUS ANGIOPLASTY IN THE TREATMENT OF VASCULAR ACCESS STENOSIS [J].
BEATHARD, GA .
KIDNEY INTERNATIONAL, 1992, 42 (06) :1390-1397
[3]  
CURRIER CB, 1986, SURGERY, V100, P25
[4]   MECHANISMS OF ANGIOPLASTY IN HEMODIALYSIS FISTULA STENOSES EVALUATED BY INTRAVASCULAR ULTRASOUND [J].
DAVIDSON, CJ ;
NEWMAN, GE ;
SHEIKH, KH ;
KISSLO, K ;
STACK, RS ;
SCHWAB, SJ .
KIDNEY INTERNATIONAL, 1991, 40 (01) :91-95
[5]   STRENGTH, ELASTICITY, AND PLASTICITY OF EXPANDABLE METAL STENTS - IN-VITRO STUDIES WITH 3 TYPES OF STRESS [J].
FLUECKIGER, F ;
STERNTHAL, H ;
KLEIN, GE ;
ASCHAUER, M ;
SZOLAR, D ;
KLEINHAPPL, G .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 1994, 5 (05) :745-750
[6]   AXILLARY AND SUBCLAVIAN VEIN STENOSIS - PERCUTANEOUS ANGIOPLASTY [J].
GLANZ, S ;
GORDON, DH ;
LIPKOWITZ, GS ;
BUTT, KMH ;
HONG, J ;
SCLAFANI, SJA .
RADIOLOGY, 1988, 168 (02) :371-373
[7]   USE OF WALLSTENTS FOR HEMODIALYSIS ACCESS-RELATED VENOUS STENOSES AND OCCLUSIONS UNTREATABLE WITH BALLOON ANGIOPLASTY [J].
GRAY, RJ ;
HORTON, KM ;
DOLMATCH, BL ;
RUNDBACK, JH ;
ANAISE, D ;
AQUINO, AO ;
CURRIER, CB ;
LIGHT, JA ;
SASAKI, TM .
RADIOLOGY, 1995, 195 (02) :479-484
[8]   A STUDY OF THE GEOMETRICAL AND MECHANICAL-PROPERTIES OF A SELF-EXPANDING METALLIC STENT THEORY AND EXPERIMENT [J].
JEDWAB, MR ;
CLERC, CO .
JOURNAL OF APPLIED BIOMATERIALS, 1993, 4 (01) :77-85
[9]   CORRECTION OF CENTRAL VENOUS STENOSES - USE OF ANGIOPLASTY AND VASCULAR WALLSTENTS [J].
KOVALIK, EC ;
NEWMAN, GE ;
SUHOCKI, P ;
KNELSON, M ;
SCHWAB, SJ .
KIDNEY INTERNATIONAL, 1994, 45 (04) :1177-1181
[10]  
Quinn SF, 1995, J VASC INTERV RADIOL, V6, P851, DOI 10.1016/S1051-0443(95)71200-3