The interventional treatment of venous hypertension associated with autogenous arteriovenous fistula_West China Medical Journal

Authors：

ZHAO Shengmei ^1,2 , ZHAO Qiuyan ³ , ZHOU Qin ² , ZHOU Li ² ,  CUI Tianlei ²

1. Department of Discipline Construction, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CUI Tianlei, Email: tianleicui@163.com

Keywords：

Balloon angioplasty; Arteriovenous fistula; Venous hypertension; Interventional therapy

DOI：

10.7507/1002-0179.201512094

Video：

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Objective To investigate the clinical effect and safety of balloon angioplasty (BAP) for patients with venous hypertension associated with autogenous arteriovenous fistula (AVF). Methods Thirty-three patients with venous hypertension associated with AVF were hospitalized between August 2012 and August 2014 in the Department of Nephrology, West China Hospital of Sichuan University. All of the patients received BAP therapy. The clinical characteristics and therapeutic effects were comparatively summarized before and after operation. Results Venous hypertension in all the 33 patients was caused by central venous stenosis or occlusion. Among them, there were 13 cases of stenosis on the site where the left innominate vein crossed the aorta, 10 cases of stenosis at the junction of the left innominate vein and superior vena cava, 4 cases of stenosis at the junction of the left subclavian vein and the innominate vein, 3 cases of right innominate vein stenosis, and 3 cases of innominate vein occlusion. The lesions were most common in the innominate vein. Innominate vein stenosis or occlusion occurred in 19 cases (57.6%), and stenosis at the junction of innominate vein and the superior vena cava or subclavian vein occurred in 14 cases (42.4%). Of the 33 patients, one patient with complete occlusion of the innominate vein did not receive BAP treatment because guide wire could not pass through the occlusion site. The other 32 patients underwent BAP treatment, among whom 30 (93.8%) were successful, and 2 (6.2%) failed. No obvious complications occurred. One day after BAP treatment, patients’ symptoms were significantly relieved. One to seven days later, swelling of the hands, pain, and other symptoms were relieved. In the 30 patients who underwent the treatment successfully, 29 were followed up for 3 to 24 months. Among them, 21 (72.4%) maintained clinical remission and the AVFs were functional, 6 patients (20.7%) got a restenosis later, and 2 patients died. Conclusions BAP is effective and safe for venous hypertension associated with AVF. However, the follow-up of patients has displayed the possible risk of restenosis in long-term outcomes.

Citation： Zhaoshengmei, Zhaoqiuyan, Zhouqin, Zhouli, Cuitianlei. The interventional treatment of venous hypertension associated with autogenous arteriovenous fistula. West China Medical Journal, 2017, 32(2): 179-181. doi: 10.7507/1002-0179.201512094 Copy

1.	NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis, 1997, 30(4 Suppl 3): S150-S191.
2.	Chemla ES, Korrakuti L, Makanjuola D,et al. Vascular access in hemodialysis patients with central venous obstruction or stenosis: one center’s experience. Ann Vasc Surg, 2005, 19(5): 692-698.
3.	Derakhshanfar A, Gholyaf M, Niayesh A,et al. Assessment of frequency of complications of arterio venous fistula in patients on dialysis: a two-year single center study from Iran. Saudi J Kidney Dis Transpl, 2009, 20(5): 872-875.
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5.	蒋先洪, 文津, 刘新宇, 等. 球囊血管成形术治疗自体动静脉内瘘相关静脉高压的初步研究. 中国血液净化, 2014, 13(1): 49-51.
6.	中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见. 临床肝胆病杂志, 2014, 34(3): 210-213.
7.	叶有新, 胡为民, 冯剑, 等. 腔内血管成型术治疗动静脉内瘘狭窄. 肾脏病与透析肾移植杂志, 2009, 18(3): 242-244.
8.	高堃, 王剑锋, 李惠, 等. 血液透析患者中心静脉狭窄的介入治疗. 介入放射学杂志, 2012, 21(7): 582-586.
9.	李治成, 杨莹莹, 崔天蕾, 等. 经颈静脉肝内门体分流术联合血液灌流治疗终末期肾病血液透析合并肝硬化一例. 华西医学, 2016, 31(2): 394-395.
10.	施娅雪, 张皓, 张纪蔚, 等. 血液透析患者肿胀手综合征的诊治. 中国血液净化, 2012, 11(3): 136-139.
11.	Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis, 2006, 48(Suppl 1): S248-S273.
12.	Mickley V. Central vein obstruction in vascular access. Eur J Vasc Endovasc Surg, 2006, 32(4): 439-444.
13.	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(6): 1672-1679.

1. NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcomes Quality Initiative. Am J Kidney Dis, 1997, 30(4 Suppl 3): S150-S191.
2. Chemla ES, Korrakuti L, Makanjuola D,et al. Vascular access in hemodialysis patients with central venous obstruction or stenosis: one center’s experience. Ann Vasc Surg, 2005, 19(5): 692-698.
3. Derakhshanfar A, Gholyaf M, Niayesh A,et al. Assessment of frequency of complications of arterio venous fistula in patients on dialysis: a two-year single center study from Iran. Saudi J Kidney Dis Transpl, 2009, 20(5): 872-875.
4. Wilson SE. Complications of vascular access procedures: thrombosis, venous hypertension, arterial steal, and neuropathy. Vascular Access: Principles and Practices. 3rd ed. St. Louis: Mosby-Year Book, 1996: 219-220.
5. 蒋先洪, 文津, 刘新宇, 等. 球囊血管成形术治疗自体动静脉内瘘相关静脉高压的初步研究. 中国血液净化, 2014, 13(1): 49-51.
6. 中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见. 临床肝胆病杂志, 2014, 34(3): 210-213.
7. 叶有新, 胡为民, 冯剑, 等. 腔内血管成型术治疗动静脉内瘘狭窄. 肾脏病与透析肾移植杂志, 2009, 18(3): 242-244.
8. 高堃, 王剑锋, 李惠, 等. 血液透析患者中心静脉狭窄的介入治疗. 介入放射学杂志, 2012, 21(7): 582-586.
9. 李治成, 杨莹莹, 崔天蕾, 等. 经颈静脉肝内门体分流术联合血液灌流治疗终末期肾病血液透析合并肝硬化一例. 华西医学, 2016, 31(2): 394-395.
10. 施娅雪, 张皓, 张纪蔚, 等. 血液透析患者肿胀手综合征的诊治. 中国血液净化, 2012, 11(3): 136-139.
11. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis, 2006, 48(Suppl 1): S248-S273.
12. Mickley V. Central vein obstruction in vascular access. Eur J Vasc Endovasc Surg, 2006, 32(4): 439-444.
13. 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(6): 1672-1679.

West China Medical Journal

The interventional treatment of venous hypertension associated with autogenous arteriovenous fistula

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