BACKGROUNDEndovascular recanalization (EVR) is becoming the primary therapy for patients with central venous (brachiocephalic, subclavian, and superior vena cava) occlusion (CVO) caused by benign etiology. In this study, we retrospectively analyzed our experience in using EVR to treat benign CVO in 10 patients between April 2005 and September 2010.

METHODSThe mean age of the patients was 65.3 years, 2/10 cases were female, and the origin of cause of CVO in 7/10 cases was the hemodialysis access in the upper extremity. The patients were treated with primary stent placement and evaluated with immediate technical success rate and post-interventional patency rate after the procedure.

RESULTSEight patients were treated successfully with stent placement and experienced symptomatic relief immediately. No technical complications were observed during EVR treatment. Patients were followed up by ultrasonography and venography. Median follow-up was 13 months. Three patients required secondary procedures to maintain patency.

CONCLUSIONSEVR is an effective and safe treatment in patients with benign CVO. It provides immediate symptom relief and maintains a continuous access for hemodialysis.

Adult ; Aged ; Aged, 80 and over ; Brachiocephalic Veins ; pathology ; Endovascular Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Subclavian Vein ; pathology ; Vascular Diseases ; therapy ; Vena Cava, Superior ; pathology

We report a case of central venous stenosis due to a structural deformity caused by a tuberculosis-destroyed lung in a 65-year-old woman. The patient presented with left facial edema. She had a history of pulmonary tuberculosis, and the chest X-ray revealed a collapsed left lung. Angiography showed leftward deviation of the innominate vein leading to kinking and stenosis of the internal jugular vein. Stent insertion improved her facial edema.
Aged ; Brachiocephalic Veins/*pathology/radiography ; *Central Venous Pressure ; Constriction, Pathologic/*etiology/pathology/therapy ; Edema/therapy ; Female ; Humans ; Jugular Veins/pathology/radiography ; Stents ; Tuberculosis, Pulmonary/*complications/pathology/radiography ; Vascular Diseases/*etiology/pathology/therapy

BACKGROUNDCentral venous thrombosis is a serious and life-threatening complication in hemodialysis (HD) patients with an indwelling catheter. The present study aimed to investigate the prevalence and characteristics of thrombosis of the superior vena cava and auxiliary branches in Chinese HD patients with an indwelling internal jugular venous catheter and to explore its risk factors.

METHODSFifty-four patients on maintenance hemodialysis (MHD) with an indwelling catheter were enrolled in this cross-sectional study. The thrombosis of the internal jugular vein, subclavical vein, brachiocephalic vein and superior vena cava was assessed by vascular ultrasound. Collected were data on age, gender, ultrafiltration volume, Kt/V, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium, and phosphorus, and parathyroid hormone.

RESULTSThe patients were given short- or long-term double lumen central venous catheters. Among them, 42 patients had the catheter placed into the right internal jugular vein, and 12 patients into the left internal jugular vein. Different degrees of central venous thrombosis were found in 33 patients (61.1%). The prevalence of thrombosis in the jugular vein, brachiocephalic vein, subclavical vein and superior vena cava was 61.1% (33/54), 44.4% (24/54), 16.7% (9/54) and 5.6% (3/54), respectively. Among the 33 HD patients with central venous thrombosis, the percentages for one, two, three and four affected veins were 27.3% (9/33), 45.4% (15/33), 18.2% (6/33) and 9.1% (3/33), respectively. Twelve (12/33, 36.4%) of the 33 HD patients with central venous thrombosis had clinical symptoms. Nine patients (27.3%) had edema of the upper extremity and 3 (9.1%) had new-onset symptoms of pulmonary embolism such as cough, chest distress and short breath. The incidences of diabetes mellitus and malignant tumor and levels of lipoprotein a and homocysteic acid were significantly higher in the HD patients with central venous thrombosis than in those without central venous thrombosis. Logistic regressive analysis revealed that high level of homocysteic acid was the important risk factor for central venous thrombosis in HD patients with indwelling catheterization of the internal jugular vein.

CONCLUSIONSThe prevalence of central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein is quite high, especially in those patients with diabetes mellitus, malignant tumor, high levels of serum lipoprotein and homocysteic acid. Its clinical symptoms are insidious but dangerous. High level of homocysteic acid may be the important risk factor for central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein.

Adult ; Aged ; Brachiocephalic Veins ; pathology ; Catheters, Indwelling ; Cross-Sectional Studies ; Female ; Humans ; Jugular Veins ; pathology ; Logistic Models ; Male ; Middle Aged ; Renal Dialysis ; adverse effects ; Vena Cava, Superior ; pathology ; Venous Thrombosis ; epidemiology ; pathology ; Young Adult

Adolescent ; Adult ; Aged ; Brachiocephalic Veins ; pathology ; surgery ; Female ; Humans ; Jugular Veins ; transplantation ; Male ; Middle Aged ; Neoplasm Invasiveness ; Patient Selection ; Postoperative Care ; Postoperative Complications ; Retrospective Studies ; Thoracic Neoplasms ; pathology ; surgery ; Treatment Outcome ; Vena Cava, Superior ; pathology ; surgery

Stenting of the central veins is well established for treating localized venous stenosis. The techniques regarding catheter preservation for central venous catheters in the superior vena cava have been described. We describe here a method for stent implantation in the superior vena cava and the left brachiocephalic vein, and principally via a single jugular venous puncture, while saving a left sided jugular central venous catheter in a patient suffering from central venous stenosis of the superior vena cava and the left brachiocephalic vein.
Brachiocephalic Veins/*pathology ; Carcinoma, Bronchogenic/complications/drug therapy ; *Catheterization, Central Venous/methods ; Catheters, Indwelling ; Constriction, Pathologic ; Endovascular Procedures/*methods ; Humans ; Lung Neoplasms/drug therapy ; Male ; Middle Aged ; Palliative Care ; *Stents ; Vena Cava, Superior/*pathology