血液透析血管通路中央静脉狭窄:临床表现及当代处理策略

Gift Echefu, Ifeoluwa Stowe, Abdulkareem Lukan, Gaurav Sharma, Indranill Basu-Ray, London Guidry, Jon Schellack, Damodar Kumbala
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引用次数: 0

摘要

中心静脉狭窄是治疗血液透析(HD)患者的一个重要且经常遇到的问题。静脉高压常伴有严重症状,破坏血液透析通路的完整性。在中心静脉狭窄中,通过动静脉瘘进行透析通常效率低下,透析后再循环率高,出血时间延长。中心静脉狭窄是一种已知的血管内和心脏装置内留置的并发症,如外周插入中心导管、长期套管式血液透析导管和起搏器导线。因此,预防这种具有挑战性的情况需要尽量减少中心静脉导管的使用。血管内介入治疗是治疗中央静脉狭窄的主要方法。经皮血管成形术和支架置入可以重建弹性和复发病变的血管功能。目前,由于现有的管理方法具有广泛的通畅率,因此对于最佳治疗方法尚无共识。
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Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies
Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.
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