Abstract: FR-PO764
Sharp Recanalization of Central Venous Occlusions in Hemodialysis Patients
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Felipe, Carlos rafael Almeida, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
- Alvarenga, Andre Sousa, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
- Pereira jr, Gerson Marques, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
- Jorge, Ana elisa Souza, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
- Bedeti, Antonio carlos Mansur, Santa Casa, Belo Horizonte, Brazil
Background
Central venous occlusion (CVO) is a severe vascular complication that causes massive upper extremity swelling and dysfunctional dialysis access. Management is aimed at providing symptomatic relief and maintaining hemodialysis access site patency.
Methods
A total of 14 hemodialysis patients with massive upper extremity swelling and dysfunctional dialysis access, who underwent endovascular recanalization for CVO at our institute between November-2013 and May-2016 were examined. We evaluated procedure sucess rate, complication rate, primary and secondary patency rate.
Results
There were 12 occlusions in brachiocephalic veins and 2 in suclavian veins. Until this procedure, each patient had lost on average 5.1 vascular access. First, we tried to traverse the occlusion using soft tip of hydrophilic wire under angiographic catheter (conventional technique); if failure, we switched to sharp recanalization technique using stiff end of hydrophilic wire to puncture the fibrotic cap to create a channel that was crossed by the soft tip of same hydrophilic wire. The procedure was considered successful when residual lesion was <30%.
Succes of conventional technique were 28.6%. Switch to sharp recanalization resulted in overall success rate of 85.7% without any major complications. It maintained the patency of dialysis access and relieved the symptoms in all cases. At 12 months, the primary and secondary patency rates were 75% and 83.3% respectively. At an average follow-up of 12.8 months, there was one death not related to the procedure.
Conclusion
Sharp recanalization of symptomatic central venous occlusions in hemodialysis patients was an effective and safe method to maintain the patency of dialysis access and to relieve the symptoms.