Kronik Böbrek Yetmezlikli Hastalarda Santral Ven Stenoz ve Oklüzyonu
Özet
Santral ven stenozu ve oklüzyonu (SVSO); aksiller ven, subklavien ven, internal juguler ven, sağ ve sol brakiyosefalik venler ve vena kava süperiorda gelişen darlık ve tıkanıklıkları tanımlamaktadır. Nedenler arasında akciğer kanseri, lenfoma gibi dışardan bası yapan kitleler ve intravenöz yerleştirilen diyaliz kateterleri, santral ven kateterleri, periferik yerleştirilen beslenme amaçlı santral kateterler ve kardiyak implante edilebilir elektronik cihazlar(KİEEC)’ı sayabiliriz. Özellikle kronik böbrek yetmezlikli (KBY) hastalarda çoğu zaman birden fazla kez yerleştirilen kalıcı kateterler ciddi oranda SVSO’na neden olabilmektedir. KBY hastalarında SVSO vasküler erişim kaybına yol açarak prognozu kötü yönde etkilemektedir. Kateterle ilişkili stenoz muhtemelen ilk giriş travması ve bunu takip eden endotelyal hasar ve damar duvarında inflamatuvar yanıtla ilişkili olduğu düşünülmektedir. SVSO çoğunlukla asemptomatik seyrettiği için gerçek sıklığı bilinmemektedir. Genellikle ilişkili ekstremiteye arteriyo-venöz fistül(AVF) oluşturulduğunda veya kateter için girişim yapılması planlandığında saptanır. AVF oluşturulduğunda o ekstremitede venöz hipertansiyona bağlı kolda ödem, göğüs ön duvarında kollateraller, dermatosklerozis, ülser ve vena kava süperior sendromu bulguları görülebilir. Tanı klinik bulgular varlığında venografi ile konulur. Tedavide amaç hastada oluşan venöz hipertansiyona bağlı bulguları azaltmak veya ortadan kaldırmak ve hemodiyalize devam edebilmesi için uygun bir yolun devamını sağlamak olmalıdır. Asemptomatik hastalarda tedavi önerilmemektedir. Semptomatik hastalarda ilk tedavi seçeneği endovasküler tedavi olmalıdır. Bazı durumlarda cerrahi tedavi de gerekebilmektedir.
Central vein stenosis and occlusion (CVSO); It describes stenosis and occlusions developing in the axillary vein, subclavian vein, internal jugular vein, right and left brachiocephalic veins and superior vena cava. Among the causes, we can list externally compressive masses such as lung cancer, lymphoma, and intravenously placed dialysis catheters, central vein catheters, peripherally placed central catheters for nutrition purposes, and cardiac implantable electronic devices (CIEC). Particularly in patients with chronic kidney failure (CKD), permanent catheters, which are often placed more than once, can cause serious CVSO. In CKD patients, SVSO causes loss of vascular access, affecting the prognosis negatively. Catheter-related stenosis is thought to be probably related to initial insertion trauma and subsequent endothelial damage and inflammatory response in the vessel wall. Since CVSO is mostly asymptomatic, its true frequency is unknown. It is usually detected when an arterio-venous fistula (AVF) is created in the relevant extremity or when an intervention for a catheter is planned. When AVF is created, edema in the arm due to venous hypertension in that extremity, collaterals on the anterior chest wall, dermatosclerosis, ulcer and superior vena cava syndrome findings may be observed. Diagnosis is made by venography in the presence of clinical findings. The aim of treatment should be to reduce or eliminate the symptoms of venous hypertension in the patient and to ensure the continuation of a suitable pathway for hemodialysis. Treatment is not recommended in asymptomatic patients. The first treatment option in symptomatic patients should be endovascular treatment. In some cases, surgical treatment may also be required.
Referanslar
Toomay, S., Rectenwald, J. and Vazquez, M.A. (2016), How Can the Complications of Central Vein Catheters Be Reduced?. Semin Dial, 29: 201-203. https://doi.org/10.1111/sdi.12478
Dolmatch BL, Gurley JC, Baskin KM, et al. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction: Endorsed by the American Society of Diagnostic and Interventional Nephrology (ASDIN), British Society of Interventional Radiology (BSIR), Canadian Interventional Radiology Association (CIRA), Heart Rhythm Society (HRS), Indian Society of Vascular and Interventional Radiology (ISVIR), Vascular Access Society of the Americas (VASA), and Vascular Access Society of Britain and Ireland (VASBI). J Vasc Interv Radiol 2018; 29:454.
Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist's perspective. Semin Dial. 2007 Jan-Feb;20(1):53-62. doi: 10.1111/j.1525-139X.2007.00242.x. PMID: 17244123.
MacRae JM, Ahmed A, Johnson N, et al. Central vein stenosis: a common problem in patients on hemodialysis. ASAIO J 2005; 51:77.
Oguzkurt L, Tercan F, Yildirim S, Torun D. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005; 55:237.
Tedla FM, Clerger G, Distant D, Salifu M. Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping. Clin J Am Soc Nephrol 2018; 13:1063.
Taal MW, Chesterton LJ, McIntyre CW. Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals significant occult stenosis. Nephrol Dial Transplant 2004; 19:1542.
Mickley V: Central venous catheters: many questions, few answers. Nephrol Dial Transplant 17:1368–1373, 2002
Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6:722.
Vanherweghem JL, Yassine T, Goldman M, vandenbosch G, Delcour C, Struyven J, Kinnaert P: Subclavian vein thrombosis: a frequent complication of subclavian vein cannulation for hemodialysis. Clin Nephrol 26:235–238, 1986
Trerotola SO, Kuhn-Fulton J, Johnson MS, et al. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 2000; 217:89.
wak K. Cardiac implantable electronic device and vascular access: Strategies to overcome problems. J Vasc Access 2018; 19:521.
Verstandig AG, Berelowitz D, Zaghal I, et al. Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access. J Vasc Interv Radiol 2013; 24:1280.
Itkin M, Kraus MJ, Trerotola SO. Extrinsic compression of the left innominate vein in hemodialysis patients. J Vasc Interv Radiol 2004; 15:51.
Glass C, Dugan M, Gillespie D, et al. Costoclavicular venous decompression in patients with threatened arteriovenous hemodialysis access. Ann Vasc Surg 2011; 25:640.
Illig KA, Gabbard W, Calero A, et al. Aggressive Costoclavicular Junction Decompression in Patients with Threatened AV Access. Ann Vasc Surg 2015; 29:698.
Illig KA. Management of central vein stenoses and occlusions: the critical importance of the costoclavicular junction. Semin Vasc Surg 2011; 24:113.
Quaretti P, Galli F, Moramarco LP, et al. Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients. Vasc Endovascular Surg 2016; 50:221.
Shi Y, Zhu M, Cheng J, Zhang J, Ni Z. Venous stenosis in chronic dialysis patients with a well-functioning arteriovenous fistula. Vascular. 2016;24(1):25-30. doi:10.1177/1708538115575649
Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update [published correction appears in Am J Kidney Dis. 2021 Apr;77(4):551. doi: 10.1053/j.ajkd.2021.02.002]. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164. doi:10.1053/j.ajkd.2019.12.001
Rajan DK, Chennepragada SM, Lok CE, et al. Patency of endovascular treatment for central venous stenosis: is there a difference between dialysis fistulas and grafts? J Vasc Interv Radiol 2007; 18:353.
Kovalik EC, Newman GE, Suhocki P, et al. Correction of central venous stenoses: use of angioplasty and vascular Wallstents. Kidney Int 1994; 45:1177.
Kim YC, Won JY, Choi SY, et al. Percutaneous treatment of central venous stenosis in hemodialysis patients: long-term outcomes. Cardiovasc Intervent Radiol 2009; 32:271.
Vesely TM, Hovsepian DM, Pilgram TK, et al. Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents. Radiology 1997; 204:343.
Aytekin C, Boyvat F, Yağmurdur MC, et al. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients. Eur J Radiol 2004; 49:81.
Jones RG, Willis AP, Jones C, et al. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol 2011; 22:1240.
Referanslar
Toomay, S., Rectenwald, J. and Vazquez, M.A. (2016), How Can the Complications of Central Vein Catheters Be Reduced?. Semin Dial, 29: 201-203. https://doi.org/10.1111/sdi.12478
Dolmatch BL, Gurley JC, Baskin KM, et al. Society of Interventional Radiology Reporting Standards for Thoracic Central Vein Obstruction: Endorsed by the American Society of Diagnostic and Interventional Nephrology (ASDIN), British Society of Interventional Radiology (BSIR), Canadian Interventional Radiology Association (CIRA), Heart Rhythm Society (HRS), Indian Society of Vascular and Interventional Radiology (ISVIR), Vascular Access Society of the Americas (VASA), and Vascular Access Society of Britain and Ireland (VASBI). J Vasc Interv Radiol 2018; 29:454.
Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist's perspective. Semin Dial. 2007 Jan-Feb;20(1):53-62. doi: 10.1111/j.1525-139X.2007.00242.x. PMID: 17244123.
MacRae JM, Ahmed A, Johnson N, et al. Central vein stenosis: a common problem in patients on hemodialysis. ASAIO J 2005; 51:77.
Oguzkurt L, Tercan F, Yildirim S, Torun D. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005; 55:237.
Tedla FM, Clerger G, Distant D, Salifu M. Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping. Clin J Am Soc Nephrol 2018; 13:1063.
Taal MW, Chesterton LJ, McIntyre CW. Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals significant occult stenosis. Nephrol Dial Transplant 2004; 19:1542.
Mickley V: Central venous catheters: many questions, few answers. Nephrol Dial Transplant 17:1368–1373, 2002
Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6:722.
Vanherweghem JL, Yassine T, Goldman M, vandenbosch G, Delcour C, Struyven J, Kinnaert P: Subclavian vein thrombosis: a frequent complication of subclavian vein cannulation for hemodialysis. Clin Nephrol 26:235–238, 1986
Trerotola SO, Kuhn-Fulton J, Johnson MS, et al. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 2000; 217:89.
wak K. Cardiac implantable electronic device and vascular access: Strategies to overcome problems. J Vasc Access 2018; 19:521.
Verstandig AG, Berelowitz D, Zaghal I, et al. Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access. J Vasc Interv Radiol 2013; 24:1280.
Itkin M, Kraus MJ, Trerotola SO. Extrinsic compression of the left innominate vein in hemodialysis patients. J Vasc Interv Radiol 2004; 15:51.
Glass C, Dugan M, Gillespie D, et al. Costoclavicular venous decompression in patients with threatened arteriovenous hemodialysis access. Ann Vasc Surg 2011; 25:640.
Illig KA, Gabbard W, Calero A, et al. Aggressive Costoclavicular Junction Decompression in Patients with Threatened AV Access. Ann Vasc Surg 2015; 29:698.
Illig KA. Management of central vein stenoses and occlusions: the critical importance of the costoclavicular junction. Semin Vasc Surg 2011; 24:113.
Quaretti P, Galli F, Moramarco LP, et al. Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients. Vasc Endovascular Surg 2016; 50:221.
Shi Y, Zhu M, Cheng J, Zhang J, Ni Z. Venous stenosis in chronic dialysis patients with a well-functioning arteriovenous fistula. Vascular. 2016;24(1):25-30. doi:10.1177/1708538115575649
Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update [published correction appears in Am J Kidney Dis. 2021 Apr;77(4):551. doi: 10.1053/j.ajkd.2021.02.002]. Am J Kidney Dis. 2020;75(4 Suppl 2):S1-S164. doi:10.1053/j.ajkd.2019.12.001
Rajan DK, Chennepragada SM, Lok CE, et al. Patency of endovascular treatment for central venous stenosis: is there a difference between dialysis fistulas and grafts? J Vasc Interv Radiol 2007; 18:353.
Kovalik EC, Newman GE, Suhocki P, et al. Correction of central venous stenoses: use of angioplasty and vascular Wallstents. Kidney Int 1994; 45:1177.
Kim YC, Won JY, Choi SY, et al. Percutaneous treatment of central venous stenosis in hemodialysis patients: long-term outcomes. Cardiovasc Intervent Radiol 2009; 32:271.
Vesely TM, Hovsepian DM, Pilgram TK, et al. Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents. Radiology 1997; 204:343.
Aytekin C, Boyvat F, Yağmurdur MC, et al. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients. Eur J Radiol 2004; 49:81.
Jones RG, Willis AP, Jones C, et al. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol 2011; 22:1240.
