Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.210130
Jornal Vascular Brasileiro
Original Article

Tratamento endovascular de doença oclusiva venosa central com fístula arteriovenosa funcionante

Endovascular treatment of central vein occlusion in patients with functioning arteriovenous fistulas

Alex Aparecido Cantador; Lucas Lembrança Pinheiro; Ana Terezinha Guillaumon

Downloads: 6
Views: 1405

Resumo

Resumo: Contexto: A maior sobrevida dos doentes dialíticos somada à incapacidade de obtenção de órgãos suficientes para atender a demanda, bem como à dificuldade de acesso aos serviços de saúde, levou ao aumento da fila para transplante e ao prolongamento do tempo de utilização do acesso venoso central para hemodiálise. A etiologia mais comum de estenose de veia central é o acesso venoso central prolongado, pelas lesões intimais decorrentes da presença do cateter.

Objetivos: Avaliar resultados de angioplastia para tratamento de doença oclusiva venosa central com fístula arteriovenosa periférica funcionante.

Métodos: Estudo tipo coorte retrospectivo com revisão de prontuários de 47 doentes com lesões estenóticas ou oclusivas. A avaliação dos doentes foi realizada em 30 dias, 6 meses e 1 ano após a recanalização ou correção da estenose com ATP ou ATP/aplicação de stent.

Resultados: Lesões estenóticas foram encontradas em 25 doentes (53%), e oclusões, em 22 (47%) doentes. A angioplastia percutânea transluminal (ATP) com stent foi utilizada em 64% dos doentes, e angioplastia isolada com balão, em 36% deles. A análise de resultados clínicos mostrou elevada taxa de melhora clínica precoce (30 dias) em 82% dos doentes (intervalo de confiança [IC] 71-93%). Após 1 ano de seguimento, a taxa de perviedade primária foi de 57%, e a taxa de perviedade primária assistida foi de 72% (IC 57-84%).

Conclusão: O tratamento endovascular das estenoses ou oclusões de veia central sugere melhora clínica dos sintomas e taxas adequadas de perviedade no período de 1 ano, apesar da limitação no tamanho amostral.

Palavras-chave

estenose, veia central, angioplastia, stent

Abstract

Background: The increased survival of dialysis patients and the inability to obtain sufficient organs to meet demand for transplantation, compounded by poor access to health services, have caused the transplant waiting lists to grow, extending the time spent using central venous accesses for hemodialysis. The most common etiology of central vein stenosis is prolonged central venous access, due to intimal injuries caused by the presence of the catheter. Objectives: To assess the results of angioplasty to treat central vein occlusion in patients with functioning peripheral arteriovenous fistulas. Methods: Retrospective cohort study with review of medical records from 47 patients with stenotic or occlusive lesions. Patients were assessed at 30 days, 6 months, and 1 year after recanalization or correction of stenosis with transluminal percutaneous angioplasty (TPA) or TPA/stenting. Results: Stenotic lesions were detected in 25 patients (53%) and occlusions were found in 22 (47%) patients. TPA with stenting was used in 64% of patients and balloon angioplasty in isolation was used in 36%. Analysis of clinical results showed a high rate of early clinical improvement (30 days), seen in 82% of patients (confidence interval [CI] 71-93%). After 1 year of follow-up, the primary patency rate was 57% and the assisted primary patency rate was 72% (CI 57-84%). Conclusions: Endovascular treatment of central vein stenosis or occlusions suggests clinical improvement of symptoms and adequate rates of patency at 1 year, notwithstanding the limited sample size.

Keywords

stenosis; central vein; angioplasty; stent.

References

1 Agarwal AK. Central vein stenosis. Am J Kidney Dis. 2013;61(6):1001-15. http://dx.doi.org/10.1053/j.ajkd.2012.10.024. PMid:23291234.

2 Kohl KH, Tan C. Central vein stenosis in end stage renal failure patients. J R Coll Physicians Edinb. 2005;35:116-22.

3 Donald MJ, Martin LG, Hughes JD, Kikeri D, Scout DC, Harker LA. Distribution and severity of stenoses in functioning arteriovenous grafts: a duplex and angiographic study. J Vasc Technol. 1996;20:131-6.

4 Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int. 1988;33(6):1156-9. http://dx.doi.org/10.1038/ki.1988.124. PMid:2969991.

5 Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int. 1992;42(6):1390-7. http://dx.doi.org/10.1038/ki.1992.431. PMid:1474770.

6 Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg. 2007;45(4):776-83. http://dx.doi.org/10.1016/j.jvs.2006.12.046. PMid:17398386.

7 Aruny JE, Lewis CA, Cardella JF, et al. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. J Vasc Interv Radiol. 2003;14(9 Pt 2):S247-53. PMid:14514827.

8 Kovalik EC, Newman GE, Suhocki P, Knelson M, Schwab SJ. Correction of central venous stenoses: use of angioplasty and vascular Wallstents. Kidney Int. 1994;45(4):1177-81. http://dx.doi.org/10.1038/ki.1994.156. PMid:8007589.

9 Silvestre JMS, Trevisan FB, Sardinha WE, et al. Endovascular treatment of occlusive central venous disease: one Center’s experience. J Vasc Bras. 2014;13(2):94-100. http://dx.doi.org/10.1590/jvb.2014.052.

10 Cuthbert GA, Lo ZJ, Kwan J, Chandrasekar S, Tan GWL. Outcomes of central venoplasty in haemodialysis patients. Ann Vasc Dis. 2018;11(3):292-7. http://dx.doi.org/10.3400/avd.oa.18-00025. PMid:30402178.

11 Chen CY, Liang HL, Pan HB, et al. Metallic stenting for treatment of central venous obstruction in hemodialysis patients. J Chin Med Assoc. 2003;66(3):166-72. PMid:12779037.

12 Vogel PM, Parise CP. SMART stent for salvage of hemodialysis access grafts. J Vasc Interv Radiol. 2004;15(10):1051-60. http://dx.doi.org/10.1097/01.RVI.0000129915.48500.DC. PMid:15466790.

13 Aytekin C, Boyvat F, Yağmurdur MC, Moray G, Haberal M. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients. Eur J Radiol. 2004;49(1):81-5. http://dx.doi.org/10.1016/S0720-048X(02)00370-4.

14 Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther RW. Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary wallstent placement and follow-up in 50 patients. Radiology. 1999;212(1):175-80. http://dx.doi.org/10.1148/radiology.212.1.r99jl21175. PMid:10405739.

15 Vesely TM, Hovsepian DM, Pilgram TK, Coyne DW, Shenoy S. Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents. Radiology. 1997;204(2):343-8. http://dx.doi.org/10.1148/radiology.204.2.9240518. PMid:9240518.

16 Gray RJ, Horton KM, Dolmatch BL, et al. Use of Wallstents for hemodialysis access-related venous stenoses and occlusions untreatable with balloon angioplasty. Radiology. 1995;195(2):479-84. http://dx.doi.org/10.1148/radiology.195.2.7724770. PMid:7724770.

17 Chen X, Liu Y, Wang J, Zhao J, Singh N, Zhang WW. A systematic review and meta-analysis of the risk of death and patency after application of paclitaxel-coated balloons in the hemodialysis access. J Vasc Surg. 2020;72(6):2186-2196.e3. http://dx.doi.org/10.1016/j.jvs.2020.04.525. PMid:32540324.

18 Andrawos A, Saeed H, Delaney C. A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access. J Vasc Surg Venous Lymphat Disord. 2021;9(5):1302-11. http://dx.doi.org/10.1016/j.jvsv.2021.02.014. PMid:33667742.

19 Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 Update. Am J Kidney Dis. 2020;75(4, Suppl 2):S1-164. http://dx.doi.org/10.1053/j.ajkd.2019.12.001. PMid:32778223.
 


Submitted date:
07/12/2021

Accepted date:
01/13/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
6241c3eaa953956da313da73 jvb Articles

J Vasc Bras

Share this page
Page Sections