Thorakale zentralvenöse Obstruktionen und arteriovenöser Zugang

Zusammenfassung

Benigne zentralvenöse thorakale Obstruktionen haben bei Hämodialysepatienten eine hohe Prävalenz. Die symptomatischen Stenosen führen zur Verschlechterung der Lebensqualität sowie zu Dysfunktionen der arteriovenösen Dialysezugänge bis hin zum Verschluss. Auch eine Implantation eines zentralvenösen Katheters kann dadurch erschwert oder unmöglich gemacht werden. Zu den Risikofaktoren zählen in erster Linie ein Vorhandensein oder eine Vorgeschichte eines zentralvenösen Katheters oder einer Schrittmachersonde. Die Diagnose kann meistens aufgrund der typischen Symptomatik vermutet werden, die digitale Subtraktionsangiografie bleibt als bildgebende Methode der Goldstandard der Diagnostik. Asymptomatische Patienten profitieren nicht von einer prophylaktischen Behandlung, diese kann oft zur raschen morphologischen und klinischen Progredienz der Stenose führen. Endovaskuläre Techniken stellen die primäre Therapieoption dar, die chirurgischen Maßnahmen sind Patienten ohne endovaskuläre Therapieoptionen vorbehalten. Die Standardtherapie ist die repetitive perkutane Ballonangioplastie. Eine Insertion eines nicht ummantelten Metallstents kann bei einem elastischen Recoiling bzw. bei einem Frührezidiv sinnvoll sein. Ein Einsatz eines Stentgrafts sollte in selektierten Fällen abgewogen werden. Der Stellenwert der neuen Techniken, wie die Anwendung dedizierter venöser Stents bzw. medikamentenbeschichteter Ballons, sollte im Rahmen von randomisierten Studien geprüft werden.

Abstract

Benign central venous thoracic occlusion is a frequent issue in haemodialysis patients. Symptomatic stenosis affects quality of life and can cause dysfunction of arteriovenous access or make it impossible to implant a haemodialysis catheter. Common risk factors for the development of the occlusions are central venous catheters and cardiac rhythm devices. The gold standard for diagnosis is venous angiography. Treatment of asymptomatic lesions can lead to clinical deterioration and should be avoided. The primary method of treatment for symptomatic patients is endovascular therapy. Repeat balloon angioplasty is a standard therapy. In case of elastic recoiling or early recurrence, placement of bare metal stent or stent graft could be considered. Surgical options should be preserved only for refractory cases. Further randomised trials are needed to prove the efficacy of new devices, such as dedicated venous stents and drug coated balloons.

Schlüsselwörter

Angioplastie - endovaskuläre Therapie - Dialyseshunt - Gefäßintervention - Stenose - Stent

Key words

angioplasty - dialysis shunt - endovascular treatment - stent

Publication History

Article published online:
02 March 2020

• Literatur

• 1 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 Access 2019; 20: 114-122 doi:10.1177/1129729818791409
• 2 Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68: 529-544 doi:10.1016/j.crad.2012.10.013
• 3 Hernandez D, Diaz F, Rufino M. et al. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors. J Am Soc Nephrol 1998; 9: 1507-1510
• 4 Naroienejad M, Saedi D, Rezvani A. Prevalence of central vein stenosis following catheterization in patients with end-stage renal disease. Saudi J Kidney Dis Transpl 2010; 21: 975-978
• 5 Tedla FM, Clerger G, Distant D. et al. Prevalence of central vein stenosis in patients referred for vein mapping. Clin J Am Soc Nephrol 2018; 13: 1063-1068 doi:10.2215/CJN.14001217
• 6 Oguzkurt L, Tercan F, Yildirim S. et al. Central venous stenosis in haemodialysis patients without a previous history of catheter placement. Eur J Radiol 2005; 55: 237-242 doi:10.1016/j.ejrad.2004.11.006
• 7 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: 353-359 doi:10.1016/j.jvir.2007.01.012
• 8 Krishna VN, Eason JB, Allon M. Central venous occlusion in the hemodialysis patient. Am J Kidney Dis 2016; 68: 803-807 doi:10.1053/j.ajkd.2016.05.017
• 9 Osman OO, El-Magzoub AR, Elamin S. Prevalence and risk factors of central venous stenosis among prevalent hemodialysis patients, a single center experience. Arab J Nephrol Transplant 2014; 7: 45-47
• 10 Schillinger F, Schillinger D, Montagnac R. et al. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991; 6: 722-724 doi:10.1093/ndt/6.10.722
• 11 Trerotola SO, Kothari S, Sammarco TE. et al. Central venous stenosis is more often symptomatic in hemodialysis patients with grafts compared with fistulas. J Vasc Interv Radiol 2015; 26: 240-246 doi:10.1016/j.jvir.2014.10.048
• 12 Drew DA, Meyer KB, Weiner DE. Transvenous cardiac device wires and vascular access in hemodialysis patients. Am J Kidney Dis 2011; 58: 494-496 doi:10.1053/j.ajkd.2011.05.005
• 13 Saad TF, Hentschel DM, Koplan B. et al. Cardiovascular implantable electronic device leads in CKD and ESRD patients: review and recommendations for practice. Semin Dial 2013; 26: 114-123 doi:10.1111/j.1525-139X.2012.01103.x
• 14 Schwab SJ, Quarles LD, Middleton JP. et al. Hemodialysis-associated subclavian vein stenosis. Kidney Int 1988; 33: 1156-1159
• 15 Agarwal AK. Central vein stenosis. Am J Kidney Dis 2013; 61: 1001-1015 doi:10.1053/j.ajkd.2012.10.024
• 16 Kundu S. Review of central venous disease in hemodialysis patients. J Vasc Interv Radiol 2010; 21: 963-968 doi:10.1016/j.jvir.2010.01.044
• 17 Kundu S. Central venous disease in hemodialysis patients: prevalence, etiology and treatment. J Vasc Access 2010; 11: 1-7
• 18 Modabber M, Kundu S. Central venous disease in hemodialysis patients: an update. Cardiovasc Intervent Radiol 2013; 36: 898-903 doi:10.1007/s00270-012-0498-6
• 19 Rose SC, Kinney TB, Bundens WP. et al. Importance of Doppler analysis of transmitted atrial waveforms prior to placement of central venous access catheters. J Vasc Interv Radiol 1998; 9: 927-934
• 20 Schmidli J, Widmer MK, Basile C. et al. Editorʼs choice – vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757-818 doi:10.1016/j.ejvs.2018.02.001
• 21 Levit RD, Cohen RM, Kwak A. et al. Asymptomatic central venous stenosis in hemodialysis patients. Radiology 2006; 238: 1051-1056 doi:10.1148/radiol.2383050119
• 22 Glanz S, Gordon D, Butt KM. et al. Dialysis access fistulas: treatment of stenoses by transluminal angioplasty. Radiology 1984; 152: 637-642 doi:10.1148/radiology.152.3.6235537
• 23 Bakken AM, Protack CD, Saad WE. et al. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg 2007; 45: 776-783 doi:10.1016/j.jvs.2006.12.046
• 24 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: 271-278 doi:10.1007/s00270-009-9511-0
• 25 Ozyer U, Harman A, Yildirim E. et al. Long-term results of angioplasty and stent placement for treatment of central venous obstruction in 126 hemodialysis patients: a 10-year single-center experience. AJR Am J Roentgenol 2009; 193: 1672-1679 doi:10.2214/AJR.09.2654
• 26 Kovalik EC, Newman GE, Suhocki P. et al. Correction of central venous stenoses: use of angioplasty and vascular Wallstents. Kidney Int 1994; 45: 1177-1181
• 27 Dammers R, de Haan MW, Planken NR. et al. Central vein obstruction in hemodialysis patients: results of radiological and surgical intervention. Eur J Vasc Endovasc Surg 2003; 26: 317-321
• 28 Davidson CJ, Newman GE, Sheikh KH. et al. Mechanisms of angioplasty in hemodialysis fistula stenoses evaluated by intravascular ultrasound. Kidney Int 1991; 40: 91-95
• 29 Kitrou PM, Papadimatos P, Spiliopoulos S. et al. Paclitaxel-coated balloons for the treatment of symptomatic central venous stenosis in dialysis access: results from a randomized controlled trial. J Vasc Interv Radiol 2017; 28: 811-817 doi:10.1016/j.jvir.2017.03.007
• 30 Massmann A, Fries P, Obst-Gleditsch K. et al. Paclitaxel-coated balloon angioplasty for symptomatic central vein restenosis in patients with hemodialysis fistulas. J Endovasc Ther 2015; 22: 74-79 doi:10.1177/1526602814566907
• 31 Kennedy SA, Mafeld S, Baerlocher MO. et al. Drug-coated balloon angioplasty in hemodialysis circuits: a systematic review and meta-analysis. J Vasc Interv Radiol 2019; 30: 483-494.e1 doi:10.1016/j.jvir.2019.01012
• 32 Quinn SF, Kim J, Sheley RC. Transluminally placed endovascular grafts for venous lesions in patients on hemodialysis. Cardiovasc Intervent Radiol 2003; 26: 365-369
• 33 Anaya-Ayala JE, Smolock CJ, Colvard BD. et al. Efficacy of covered stent placement for central venous occlusive disease in hemodialysis patients. J Vasc Surg 2011; 54: 754-759 doi:10.1016/j.jvs.2011.03.260
• 34 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: 1240-1245 doi:10.1016/j.jvir.2011.06.002
• 35 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: 1280-1287 doi:10.1016/j.jvir.2013.04.016
• 36 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: 166-172
• 37 Aytekin C, Boyvat F, Yagmurdur MC. et al. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients. Eur J Radiol 2004; 49: 81-85 doi:10.1016/S0720-048X(02)00370-4
• 38 de Graaf R, van Laanen J, Sailer A. et al. Long segment recanalization and dedicated central venous stenting in an ultimate attempt to restore vascular access central vein outflow. J Vasc Access 2014; 15 (Suppl. 07) S109-S113 doi:10.5301/jva.5000251
• 39 Kang CH, Yang SB, Lee WH. et al. Comparison of open-cell stent and closed-cell stent for treatment of central vein stenosis or occlusion in hemodialysis patients. Iran J Radiol 2016; 13: e37994 doi:10.5812/iranjradiol.37994
• 40 Dabir D, Feisst A, Thomas D. et al. Physical properties of venous stents: an experimental comparison. Cardiovasc Intervent Radiol 2018; 41: 942-950 doi:10.1007/s00270-018-1916-1
• 41 Lichtenberg M, de Graaf R, Erbel C. Standards for recanalisation of chronic venous outflow obstructions. Vasa 2018; 47: 259-266 doi:10.1024/0301-1526/a000696
• 42 Asif A, Salman L, Carrillo RG. et al. Patency rates for angioplasty in the treatment of pacemaker-induced central venous stenosis in hemodialysis patients: results of a multi-center study. Semin Dial 2009; 22: 671-676 doi:10.1111/j.1525-139X.2009.00636.x
• 43 Slonim SM, Semba CP, Sze DY. et al. Placement of SVC stents over pacemaker wires for the treatment of SVC syndrome. J Vasc Interv Radiol 2000; 11: 215-219
• 44 Anaya-Ayala JE, Bellows PH, Ismail N. et al. Surgical management of hemodialysis-related central venous occlusive disease: a treatment algorithm. Ann Vasc Surg 2011; 25: 108-119 doi:10.1016/j.avsg.2010.11.002
• 45 Cline BC, Gage SM, Ronald J. et al. Treatment of arm swelling in hemodialysis patients with ipsilateral arteriovenous access and central vein stenosis: conversion to the hemodialysis reliable outflow graft versus stent deployment. J Vasc Interv Radiol 2019;
• 46 Funaki B. Unconventional central access: catheter insertion in collateral or in recanalized veins. Semin Intervent Radiol 2004; 21: 111-117 doi:10.1055/s-2004-833684
• 47 Too CW, Sayani R, Lim EY. et al. REcanalisation and Balloon-Oriented puncture for Re-insertion of dialysis catheter in Nonpatent central veins (REBORN). Cardiovasc Intervent Radiol 2016; 39: 1193-1198 doi:10.1007/s00270-016-1383-5
• 48 Hentschel DM, Minarsch L, Vega F. et al. The Surfacer^® Inside-Out^® Access System for right-sided catheter placement in dialysis patients with thoracic venous obstruction. J Vasc Access 2019;
• 49 Gagne PJ, Tahara RW, Fastabend CP. et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord 2017; 5: 678-687 doi:10.1016/j.jvsv.2017.04.007
• 50 Gagne PJ, Gasparis A, Black S. et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord 2018; 6: 48-56.e1 doi:10.1016/j.jvsv.2017.07.009