{"title":"[血液透析患者上腔静脉闭塞后重新建立血管通路]。","authors":"Min Liu, Lizhu Jin, Tianlei Cui","doi":"10.12182/20241360601","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the application of percutaneous right atrial puncture and tunneled cuffed catheter insertion and the establishment of peripheral arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO), and to provide evidence-based support for the re-establishment of vascular access in patients with limited vascular resources.</p><p><strong>Methods: </strong>Patients with SVCO were enrolled. Then, either right neck percutaneous puncture catheterization or peripheral AV access construction was performed on the patients according to their personal preference. The patients were divided into the catheter group and the AV access group accordingly. Under the guidance of double C-arm digital subtraction angiography, a puncture was made in the right brachiocephalic vein or the stump of superior vena cava. Portal venous shunt instrument RUPS100 was then inserted through the guide wire, and the hard end of the guide wire was used to puncture the right atrium to achieve sharp recanalization of the occlusive superior vena cava. Afterwards, balloon expansion of the obstructive superior vena cava lesion and the subsequent implantation of the tunneled-cuffed catheter were performed. In AV access group, after evaluating the collateral veins by venougraphy and the peripheral vessel by ultrasound, autologous AV fistula or graft was established according to the vascular conditions of the patient and their personal preferences. The demographic information and clinical outcomes, such primary and primary assisted patency of access, were documented and the incidence of complications was monitored. With the duration of patent access defined as the survival time, Kaplan-Meier survival analysis was performed to compare the patency rates of the two groups.</p><p><strong>Results: </strong>A total of 45 SVCO patients were enrolled and underwent re-establishment of vascular access. Among them, 21 cases were in the catheter group and 24 cases were in the AV access group. All patients had their vascular access successfully constructed and received hemodialysis, and no relevant complications or deaths occurred during the procedure. Over the mean follow-up period of (471.22±125.94) days, the primary patency rates in the catheter group 95.2% and 85.7% at 6 and 12 months, respectively, and the primary assisted patency rates were 100% and 95.2%, respectively. The primary patency rates of the AV access group were 79.2% and 62.5% at 6 and 12 months, and the primary assisted patency rates were 95.8% and 87.5%, respectively. No significant difference was observed between the two groups. Kaplan-Meier survival analysis showed that the median survival time (defined as the duration of patent access) was 670.00 (468.99, 871.01) days in the catheter group and 450.00 (339.24, 560.76) days in the AV access group, with the catheter group outperforming the AV access group. The primary patency rate of the catheter group was better than that of the AV access group (<i>P</i>=0.049). On the other hand, no significant difference was observed in the primary assisted patency rates of the two groups.</p><p><strong>Conclusions: </strong>Long-term vascular access can be established for SVCO patients by either percutaneous catheterization through the right atrium of superior vena cava stump or the establishment of peripheral AV access. The comprehensive plan, which includes the establishment of AV access first and the subsequent catheterization, is expected to improve the total duration of long-term vascular access and prolong the overall survival of dialysis patients, which provides new ideas for re-establishing dialysis access in patients with exhausted central venous resources.</p>","PeriodicalId":39321,"journal":{"name":"四川大学学报(医学版)","volume":"55 5","pages":"1309-1315"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536257/pdf/","citationCount":"0","resultStr":"{\"title\":\"[Re-Establishment of Vascular Access After Superior Vena Cava Occlusion in Hemodialysis Patients].\",\"authors\":\"Min Liu, Lizhu Jin, Tianlei Cui\",\"doi\":\"10.12182/20241360601\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the application of percutaneous right atrial puncture and tunneled cuffed catheter insertion and the establishment of peripheral arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO), and to provide evidence-based support for the re-establishment of vascular access in patients with limited vascular resources.</p><p><strong>Methods: </strong>Patients with SVCO were enrolled. Then, either right neck percutaneous puncture catheterization or peripheral AV access construction was performed on the patients according to their personal preference. The patients were divided into the catheter group and the AV access group accordingly. Under the guidance of double C-arm digital subtraction angiography, a puncture was made in the right brachiocephalic vein or the stump of superior vena cava. Portal venous shunt instrument RUPS100 was then inserted through the guide wire, and the hard end of the guide wire was used to puncture the right atrium to achieve sharp recanalization of the occlusive superior vena cava. Afterwards, balloon expansion of the obstructive superior vena cava lesion and the subsequent implantation of the tunneled-cuffed catheter were performed. In AV access group, after evaluating the collateral veins by venougraphy and the peripheral vessel by ultrasound, autologous AV fistula or graft was established according to the vascular conditions of the patient and their personal preferences. The demographic information and clinical outcomes, such primary and primary assisted patency of access, were documented and the incidence of complications was monitored. With the duration of patent access defined as the survival time, Kaplan-Meier survival analysis was performed to compare the patency rates of the two groups.</p><p><strong>Results: </strong>A total of 45 SVCO patients were enrolled and underwent re-establishment of vascular access. Among them, 21 cases were in the catheter group and 24 cases were in the AV access group. All patients had their vascular access successfully constructed and received hemodialysis, and no relevant complications or deaths occurred during the procedure. Over the mean follow-up period of (471.22±125.94) days, the primary patency rates in the catheter group 95.2% and 85.7% at 6 and 12 months, respectively, and the primary assisted patency rates were 100% and 95.2%, respectively. The primary patency rates of the AV access group were 79.2% and 62.5% at 6 and 12 months, and the primary assisted patency rates were 95.8% and 87.5%, respectively. No significant difference was observed between the two groups. Kaplan-Meier survival analysis showed that the median survival time (defined as the duration of patent access) was 670.00 (468.99, 871.01) days in the catheter group and 450.00 (339.24, 560.76) days in the AV access group, with the catheter group outperforming the AV access group. The primary patency rate of the catheter group was better than that of the AV access group (<i>P</i>=0.049). On the other hand, no significant difference was observed in the primary assisted patency rates of the two groups.</p><p><strong>Conclusions: </strong>Long-term vascular access can be established for SVCO patients by either percutaneous catheterization through the right atrium of superior vena cava stump or the establishment of peripheral AV access. The comprehensive plan, which includes the establishment of AV access first and the subsequent catheterization, is expected to improve the total duration of long-term vascular access and prolong the overall survival of dialysis patients, which provides new ideas for re-establishing dialysis access in patients with exhausted central venous resources.</p>\",\"PeriodicalId\":39321,\"journal\":{\"name\":\"四川大学学报(医学版)\",\"volume\":\"55 5\",\"pages\":\"1309-1315\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536257/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"四川大学学报(医学版)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.12182/20241360601\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"四川大学学报(医学版)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12182/20241360601","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的评估上腔静脉闭塞(SVCO)血液透析患者应用经皮右心房穿刺和隧道袖带导管插入以及建立外周动静脉(AV)通路的情况,并为血管资源有限的患者重建血管通路提供循证支持:方法:纳入 SVCO 患者。方法:入选 SVCO 患者,然后根据患者的个人偏好为其实施右颈部经皮穿刺导管插入术或外周动静脉通路构建术。患者被相应地分为导管组和房室通路组。在双 C 臂数字减影血管造影术的引导下,在右臂静脉或上腔静脉残端进行穿刺。然后通过导丝插入门静脉分流器 RUPS100,用导丝的硬端穿刺右心房,使闭塞的上腔静脉急剧再通。随后,对阻塞性上腔静脉病变进行球囊扩张,并植入隧道式袖带导管。在 AV 入路组中,通过静脉造影术评估侧支静脉和超声波评估外周血管后,根据患者的血管条件和个人喜好建立自体 AV 管瘘或移植。记录人口统计学信息和临床结果,如主要通路和主要辅助通路的通畅情况,并监测并发症的发生率。将通畅时间定义为存活时间,进行卡普兰-米尔存活率分析,比较两组患者的通畅率:共有 45 例 SVCO 患者接受了血管通路重建手术。其中,导管组 21 例,动静脉通路组 24 例。所有患者都成功建立了血管通路并接受了血液透析,手术过程中未出现相关并发症或死亡。在平均(471.22±125.94)天的随访期内,导管组在6个月和12个月时的主要通畅率分别为95.2%和85.7%,主要辅助通畅率分别为100%和95.2%。在 6 个月和 12 个月时,动静脉通路组的主要通畅率分别为 79.2% 和 62.5%,主要辅助通畅率分别为 95.8% 和 87.5%。两组之间无明显差异。Kaplan-Meier 生存分析显示,导管组的中位生存时间(定义为通畅时间)为 670.00 (468.99, 871.01) 天,而 AV 通路组为 450.00 (339.24, 560.76) 天,导管组优于 AV 通路组。导管组的一次通畅率优于房室入路组(P=0.049)。另一方面,两组的主要辅助通畅率无明显差异:结论:通过经皮导管插入右心房上腔静脉残端或建立外周房室通路,可为 SVCO 患者建立长期血管通路。先建立房室通路,再进行导管插入术的综合方案有望改善长期血管通路的总持续时间,延长透析患者的总生存期,这为中心静脉资源枯竭患者重建透析通路提供了新思路。
[Re-Establishment of Vascular Access After Superior Vena Cava Occlusion in Hemodialysis Patients].
Objective: To evaluate the application of percutaneous right atrial puncture and tunneled cuffed catheter insertion and the establishment of peripheral arteriovenous (AV) access in hemodialysis patients with superior vena cava occlusion (SVCO), and to provide evidence-based support for the re-establishment of vascular access in patients with limited vascular resources.
Methods: Patients with SVCO were enrolled. Then, either right neck percutaneous puncture catheterization or peripheral AV access construction was performed on the patients according to their personal preference. The patients were divided into the catheter group and the AV access group accordingly. Under the guidance of double C-arm digital subtraction angiography, a puncture was made in the right brachiocephalic vein or the stump of superior vena cava. Portal venous shunt instrument RUPS100 was then inserted through the guide wire, and the hard end of the guide wire was used to puncture the right atrium to achieve sharp recanalization of the occlusive superior vena cava. Afterwards, balloon expansion of the obstructive superior vena cava lesion and the subsequent implantation of the tunneled-cuffed catheter were performed. In AV access group, after evaluating the collateral veins by venougraphy and the peripheral vessel by ultrasound, autologous AV fistula or graft was established according to the vascular conditions of the patient and their personal preferences. The demographic information and clinical outcomes, such primary and primary assisted patency of access, were documented and the incidence of complications was monitored. With the duration of patent access defined as the survival time, Kaplan-Meier survival analysis was performed to compare the patency rates of the two groups.
Results: A total of 45 SVCO patients were enrolled and underwent re-establishment of vascular access. Among them, 21 cases were in the catheter group and 24 cases were in the AV access group. All patients had their vascular access successfully constructed and received hemodialysis, and no relevant complications or deaths occurred during the procedure. Over the mean follow-up period of (471.22±125.94) days, the primary patency rates in the catheter group 95.2% and 85.7% at 6 and 12 months, respectively, and the primary assisted patency rates were 100% and 95.2%, respectively. The primary patency rates of the AV access group were 79.2% and 62.5% at 6 and 12 months, and the primary assisted patency rates were 95.8% and 87.5%, respectively. No significant difference was observed between the two groups. Kaplan-Meier survival analysis showed that the median survival time (defined as the duration of patent access) was 670.00 (468.99, 871.01) days in the catheter group and 450.00 (339.24, 560.76) days in the AV access group, with the catheter group outperforming the AV access group. The primary patency rate of the catheter group was better than that of the AV access group (P=0.049). On the other hand, no significant difference was observed in the primary assisted patency rates of the two groups.
Conclusions: Long-term vascular access can be established for SVCO patients by either percutaneous catheterization through the right atrium of superior vena cava stump or the establishment of peripheral AV access. The comprehensive plan, which includes the establishment of AV access first and the subsequent catheterization, is expected to improve the total duration of long-term vascular access and prolong the overall survival of dialysis patients, which provides new ideas for re-establishing dialysis access in patients with exhausted central venous resources.
四川大学学报(医学版)Biochemistry, Genetics and Molecular Biology-Molecular Biology
CiteScore
0.70
自引率
0.00%
发文量
8695
期刊介绍:
"Journal of Sichuan University (Medical Edition)" is a comprehensive medical academic journal sponsored by Sichuan University, a higher education institution directly under the Ministry of Education of the People's Republic of China. It was founded in 1959 and was originally named "Journal of Sichuan Medical College". In 1986, it was renamed "Journal of West China University of Medical Sciences". In 2003, it was renamed "Journal of Sichuan University (Medical Edition)" (bimonthly).
"Journal of Sichuan University (Medical Edition)" is a Chinese core journal and a Chinese authoritative academic journal (RCCSE). It is included in the retrieval systems such as China Science and Technology Papers and Citation Database (CSTPCD), China Science Citation Database (CSCD) (core version), Peking University Library's "Overview of Chinese Core Journals", the U.S. "Index Medica" (IM/Medline), the U.S. "PubMed Central" (PMC), the U.S. "Biological Abstracts" (BA), the U.S. "Chemical Abstracts" (CA), the U.S. EBSCO, the Netherlands "Abstracts and Citation Database" (Scopus), the Japan Science and Technology Agency Database (JST), the Russian "Abstract Magazine", the Chinese Biomedical Literature CD-ROM Database (CBMdisc), the Chinese Biomedical Periodical Literature Database (CMCC), the China Academic Journal Network Full-text Database (CNKI), the Chinese Academic Journal (CD-ROM Edition), and the Wanfang Data-Digital Journal Group.