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

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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.
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.	蔣先洪, 文津, 劉新宇, 等. 球囊血管成形術治療自體動靜脈內瘺相關靜脈高壓的初步研究. 中國血液凈化, 2014, 13(1): 49-51.
6.	中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 34(3): 210-213.
7.	葉有新, 胡為民, 馮劍, 等. 腔內血管成型術治療動靜脈內瘺狹窄. 腎臟病與透析腎移植雜志, 2009, 18(3): 242-244.
8.	高堃, 王劍鋒, 李惠, 等. 血液透析患者中心靜脈狹窄的介入治療. 介入放射學雜志, 2012, 21(7): 582-586.
9.	李治成, 楊瑩瑩, 崔天蕾, 等. 經頸靜脈肝內門體分流術聯合血液灌流治療終末期腎病血液透析合并肝硬化一例. 華西醫學, 2016, 31(2): 394-395.
10.	施婭雪, 張皓, 張紀蔚, 等. 血液透析患者腫脹手綜合征的診治. 中國血液凈化, 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. 蔣先洪, 文津, 劉新宇, 等. 球囊血管成形術治療自體動靜脈內瘺相關靜脈高壓的初步研究. 中國血液凈化, 2014, 13(1): 49-51.
6. 中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 34(3): 210-213.
7. 葉有新, 胡為民, 馮劍, 等. 腔內血管成型術治療動靜脈內瘺狹窄. 腎臟病與透析腎移植雜志, 2009, 18(3): 242-244.
8. 高堃, 王劍鋒, 李惠, 等. 血液透析患者中心靜脈狹窄的介入治療. 介入放射學雜志, 2012, 21(7): 582-586.
9. 李治成, 楊瑩瑩, 崔天蕾, 等. 經頸靜脈肝內門體分流術聯合血液灌流治療終末期腎病血液透析合并肝硬化一例. 華西醫學, 2016, 31(2): 394-395.
10. 施婭雪, 張皓, 張紀蔚, 等. 血液透析患者腫脹手綜合征的診治. 中國血液凈化, 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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