[Prevalence of stenosis and thrombosis of central veins in hemodialysis after a tunneled jugular catheter].
Central venous stenosis (ST) and thrombosis (TB) related to catheter (KT) had been reported mostly for the subclavian vein. We performed a systematic cavographic study to evaluate the prevalence of these complications in 51 hemodialysis patients with present or previous history of tunneled internal jugular catheter. Each of them had used one or several KT (1.8 +/- 1.4 KT) for a mean 28 +/- 26 month cumulative time (i.e. 43,584 days total exposure time). Fifty percent of the KT were PermCath Quinton and 50% were Twincath (uncuffed) or CS 100 (cuffed) Medcomp. Twenty-seven had no ST (53%, group I), 24 had one or several significant ST (47%, group II) of superior Vena Cava (SVC, n = 4), inferior Vena Cava (IVC, n = 1), Brachio-cephalic Vein (BCV, n = 5) and subclavian vein (SC, n = 10), or a TB of SVC (n = 1), IVC (n = 3), BCV (n = 3), SC (n = 2). This accounts for an incidence of 0.55 ST or TB/1000 patient-days. Five of the twelve subclavian ST and TB had no history of previous subclavian catheter. Comparison between the two groups showed no differences according to age, time on dialysis, diabetes, hematocrit, CRP, cumulative time with catheter, catheter-related infections, type of catheter and anticoagulant treatment. IVC catheter tip's position is an important risk factor for TB and ST (4/6). Twelve group II patients had ST or TB-related symptoms, with a functional AV fistula in 9 cases. Eleven patients underwent repeated percutaneous angioplasty with 4 additional Wallstents and in 2 cases an AV fistula need to be closed. Central venous ST and TB after a jugular KT is extremely frequent, mostly without any symptoms. Consequences on peripheral or central vascular access, cost and poor long-term patency rate of angioplasty are of major importance. These results incite us to further reduce the catheter use in dialysis patients.
Jean
G
G
Centre de rein artificiel, Tassin la demi-lune, France. Gjean14357@aol.com
Vanel
T
T
Chazot
C
C
Charra
B
B
Terrat
J C
JC
Hurot
J M
JM
D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology