Hemodiyalize Giren Hastalarda Gelişen Vasküler Komplikasyonların Endovasküler Yöntemlerle Tedavisi
Özet
Hemodiyaliz hastalarında tedavinin sürekliliği, güvenilir ve uzun ömürlü bir vasküler erişim yoluna bağlıdır. Arteriovenöz fistül (AVF), arteriovenöz greft (AVG) ve santral venöz kateter (SVK) kullanılan seçenekler olmakla birlikte; stenoz, tromboz, santral venöz stenoz/oklüzyon (SVS/SVO), kateter disfonksiyonu, anevrizmatik değişiklikler, distal hipoperfüzyon iskemik sendromu (DHIS) ve yüksek akım gibi komplikasyonlarla işlevini kaybedebilir. Bu bölüm, komplikasyonları ve tedavi yöntemlerini kateter ilişkili sorunlar, SVS/SVO ve AVF/AVG disfonksiyonları başlıklarında sistematik biçimde ele almaktadır. Genel amaç, diyalizi kesintiye uğratmadan erişim ömrünü uzatmak ve venöz rezervi korumaktır. Multidisipliner ekip çalışması, hasta güvenliği ve zamanlama açısından kritiktir.
In hemodialysis patients, the continuity of treatment depends on a reliable and long-lasting vascular access route. Arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC) are available options; however, they can lose their function due to complications such as stenosis, thrombosis, central venous stenosis/occlusion (CVS/CVO), catheter dysfunction, aneurysmal changes, distal hypoperfusion ischemic syndrome (DHIS), and high flow. This section systematically addresses these complications and treatment methods under the headings of catheter-related problems, CVS/CVO, and AVF/AVG dysfunctions. The overall goal is to prolong access life and preserve venous reserve without interrupting dialysis. Multidisciplinary teamwork is critical for patient safety and timely intervention.
Referanslar
K.Kılıç AC. IE. Hemodiyaliz hastalarında gelişen vasküler komplikasyonların endovasküler yöntemlerle tedavisi [Research]. Ulusal Tez Merkezi: Gazi University; 2003.
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases. 2020;75(4):S1-S164.
Lok CE, Yuo T, Lee T. Hemodialysis Vascular Access: Core Curriculum 2025. Am J Kidney Dis. 2025;85(2):236-52.
Iguidbashian J, Imran R, Yi JA. Maintenance and Salvage of Hemodialysis Access. Surg Clin North Am. 2023;103(4):685-701.
Taskent I, Ersoy GG. Early percutaneous thrombolysis for AVF thrombosis: symptom duration as a predictor of endovascular salvage. CVIR Endovasc. 2025;8(1):67.
Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, et al. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol. 2016;27(10):1518-30.
Ghasemi-Rad M, Trinh K, Ahmadzade M, Agahi K, Jefferson X, Klusman C, et al. The Alpha to Omega of Dialysis Access: Arteriovenous Fistula and Graft (Part 1). Vasc Endovascular Surg. 2025;59(5):513-27.
Ghasemi-Rad M, Trinh K, Ahmadzade M, Agahi K, Jefferson X, Klusman C, et al. The Alpha to Omega of Dialysis Access: Evaluation, Interventions, Innovations (Part 2). Vasc Endovascular Surg. 2025;59(5):528-37.
MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, et al. Arteriovenous Access Failure, Stenosis, and Thrombosis. Can J Kidney Health Dis. 2016;3:2054358116669126.
Xu T, Zeng N, Li N. Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem. Front Cardiovasc Med. 2023;10:1063450.
Ma W, Zhao Z, Fu Q, Hu L, Zhao X, Wang C, et al. Comparison of Management for Central Venous Stenosis With or Without Previous Catheter Placement. Front Neurol. 2021;12:703286.
Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, et al. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. Front Nephrol. 2023;3:1280666.
Hohmann SE, Cha E. Technique of percutaneous closure of an endovascular arteriovenous fistula created for dialysis access. Proc (Bayl Univ Med Cent). 2023;36(3):403-5.
Guven H. The role of flow-to-diameter ratio in predicting arteriovenous fistula complications in hemodialysis. J Vasc Access. 2025:11297298251389660.
Eze AN, Cui CL, Chun TT, Southerland KW, Kim Y. Incidence and risk factors for hemodialysis access-induced distal ischemia after hemodialysis reliable outflow (HeRO) surgery. J Vasc Access. 2026:11297298261415963.
Lopez-Rubio M, Lago-Rodriguez MO, Ordieres-Ortega L, Oblitas CM, Moragon-Ledesma S, Alonso-Beato R, et al. A Comprehensive Review of Catheter-Related Thrombosis. J Clin Med. 2024;13(24).
El Graini S, El Ouali I, Retal H, Omor Y, Latib R, Amalik S. Pinch-off syndrome leading to catheter fracture: a rare complication of central venous port systems, a case report. BJR Case Rep. 2026;12(1):uaaf056.
Boulet N, Gavoille A, Iachkine J, Louart B, de Grooth HJ, Du Cheyron D, et al. Site-specific complications of central venous catheterization under systematic ultrasound guidance: a target trial emulation revisiting the 3SITES study. Crit Care. 2025;29(1):513.
Jalili J, Vaseghi S, Asvadi T, Baastani Khajeh M. Evaluating tissue plasminogen activator (tPA) in dialysis catheter dysfunction: A focus on fibrin sheath and risk factors. Am Heart J Plus. 2025;58:100595.
Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist's perspective. Semin Dial. 2007;20(1):53-62.
Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int. 1988;33(6):1156-9.
Tian R, Yu Z, Luo T. Clinical outcomes of endovascular treatment in hemodialysis patients with central venous stenosis: A retrospective analysis. Therapeutic Apheresis and Dialysis. 2025;29(3):408-18.
Uceda PV, Ahn SS. Most complex brachiocephalic vein occlusion in hemodialysis patients can be treated with simple endovascular techniques in an office-based angiosuite. J Vasc Surg Venous Lymphat Disord. 2023;11(4):761-7 e2.
Yu Y, Xiong Y, Li T, Zhou J, Yan W, Xiong Y, et al. Risk factors for in-stent restenosis in maintenance hemodialysis patients with central venous occlusive disease and biomechanical assessment of stents. J Vasc Access. 2024;25(3):943-52.
Pinelo A, Loureiro L, Mendes D, Rego D, Teixeira S, Veterano C, et al. Drug-Eluting Stents vs. Stent-Grafts in Hemodialysis Vascular Access Outflow Interventions. J Endovasc Ther. 2025:15266028251384926.
Hurwitz M, Dang QA, Scali S, Bowens N, Woo K, de Virgilio C. Diagnosis and Management of Hemodialysis Access Complications: A Review. JAMA Surg. 2025.
Kornfield ZN, Kwak A, Soulen MC, Patel AA, Kobrin SM, Cohen RM, et al. Incidence and management of percutaneous transluminal angioplasty-induced venous rupture in the "fistula first" era. J Vasc Interv Radiol. 2009;20(6):744-51.
Tran V, Olavarria-Bernal D, Cordon A, Lalmuanpuii J. Distal Hypoperfusion Ischemic Syndrome in a Patient With End-Stage Renal Disease. Cureus. 2024;16(11):e74190.
Bourquelot P, Karam L, Raynaud A, Beyssen B, Ricco JB. Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access. J Vasc Surg. 2014;59(1):260-3.
Referanslar
K.Kılıç AC. IE. Hemodiyaliz hastalarında gelişen vasküler komplikasyonların endovasküler yöntemlerle tedavisi [Research]. Ulusal Tez Merkezi: Gazi University; 2003.
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases. 2020;75(4):S1-S164.
Lok CE, Yuo T, Lee T. Hemodialysis Vascular Access: Core Curriculum 2025. Am J Kidney Dis. 2025;85(2):236-52.
Iguidbashian J, Imran R, Yi JA. Maintenance and Salvage of Hemodialysis Access. Surg Clin North Am. 2023;103(4):685-701.
Taskent I, Ersoy GG. Early percutaneous thrombolysis for AVF thrombosis: symptom duration as a predictor of endovascular salvage. CVIR Endovasc. 2025;8(1):67.
Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, et al. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol. 2016;27(10):1518-30.
Ghasemi-Rad M, Trinh K, Ahmadzade M, Agahi K, Jefferson X, Klusman C, et al. The Alpha to Omega of Dialysis Access: Arteriovenous Fistula and Graft (Part 1). Vasc Endovascular Surg. 2025;59(5):513-27.
Ghasemi-Rad M, Trinh K, Ahmadzade M, Agahi K, Jefferson X, Klusman C, et al. The Alpha to Omega of Dialysis Access: Evaluation, Interventions, Innovations (Part 2). Vasc Endovascular Surg. 2025;59(5):528-37.
MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, et al. Arteriovenous Access Failure, Stenosis, and Thrombosis. Can J Kidney Health Dis. 2016;3:2054358116669126.
Xu T, Zeng N, Li N. Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem. Front Cardiovasc Med. 2023;10:1063450.
Ma W, Zhao Z, Fu Q, Hu L, Zhao X, Wang C, et al. Comparison of Management for Central Venous Stenosis With or Without Previous Catheter Placement. Front Neurol. 2021;12:703286.
Echefu G, Stowe I, Lukan A, Sharma G, Basu-Ray I, Guidry L, et al. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. Front Nephrol. 2023;3:1280666.
Hohmann SE, Cha E. Technique of percutaneous closure of an endovascular arteriovenous fistula created for dialysis access. Proc (Bayl Univ Med Cent). 2023;36(3):403-5.
Guven H. The role of flow-to-diameter ratio in predicting arteriovenous fistula complications in hemodialysis. J Vasc Access. 2025:11297298251389660.
Eze AN, Cui CL, Chun TT, Southerland KW, Kim Y. Incidence and risk factors for hemodialysis access-induced distal ischemia after hemodialysis reliable outflow (HeRO) surgery. J Vasc Access. 2026:11297298261415963.
Lopez-Rubio M, Lago-Rodriguez MO, Ordieres-Ortega L, Oblitas CM, Moragon-Ledesma S, Alonso-Beato R, et al. A Comprehensive Review of Catheter-Related Thrombosis. J Clin Med. 2024;13(24).
El Graini S, El Ouali I, Retal H, Omor Y, Latib R, Amalik S. Pinch-off syndrome leading to catheter fracture: a rare complication of central venous port systems, a case report. BJR Case Rep. 2026;12(1):uaaf056.
Boulet N, Gavoille A, Iachkine J, Louart B, de Grooth HJ, Du Cheyron D, et al. Site-specific complications of central venous catheterization under systematic ultrasound guidance: a target trial emulation revisiting the 3SITES study. Crit Care. 2025;29(1):513.
Jalili J, Vaseghi S, Asvadi T, Baastani Khajeh M. Evaluating tissue plasminogen activator (tPA) in dialysis catheter dysfunction: A focus on fibrin sheath and risk factors. Am Heart J Plus. 2025;58:100595.
Agarwal AK, Patel BM, Haddad NJ. Central vein stenosis: a nephrologist's perspective. Semin Dial. 2007;20(1):53-62.
Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int. 1988;33(6):1156-9.
Tian R, Yu Z, Luo T. Clinical outcomes of endovascular treatment in hemodialysis patients with central venous stenosis: A retrospective analysis. Therapeutic Apheresis and Dialysis. 2025;29(3):408-18.
Uceda PV, Ahn SS. Most complex brachiocephalic vein occlusion in hemodialysis patients can be treated with simple endovascular techniques in an office-based angiosuite. J Vasc Surg Venous Lymphat Disord. 2023;11(4):761-7 e2.
Yu Y, Xiong Y, Li T, Zhou J, Yan W, Xiong Y, et al. Risk factors for in-stent restenosis in maintenance hemodialysis patients with central venous occlusive disease and biomechanical assessment of stents. J Vasc Access. 2024;25(3):943-52.
Pinelo A, Loureiro L, Mendes D, Rego D, Teixeira S, Veterano C, et al. Drug-Eluting Stents vs. Stent-Grafts in Hemodialysis Vascular Access Outflow Interventions. J Endovasc Ther. 2025:15266028251384926.
Hurwitz M, Dang QA, Scali S, Bowens N, Woo K, de Virgilio C. Diagnosis and Management of Hemodialysis Access Complications: A Review. JAMA Surg. 2025.
Kornfield ZN, Kwak A, Soulen MC, Patel AA, Kobrin SM, Cohen RM, et al. Incidence and management of percutaneous transluminal angioplasty-induced venous rupture in the "fistula first" era. J Vasc Interv Radiol. 2009;20(6):744-51.
Tran V, Olavarria-Bernal D, Cordon A, Lalmuanpuii J. Distal Hypoperfusion Ischemic Syndrome in a Patient With End-Stage Renal Disease. Cureus. 2024;16(11):e74190.
Bourquelot P, Karam L, Raynaud A, Beyssen B, Ricco JB. Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access. J Vasc Surg. 2014;59(1):260-3.
