A practical approach for diagnosis and treatment of central venous stenosis and occlusion.
Treating symptomatic central venous stenosis and occlusion is a challenge for those caring for patients with end stage renal disease. With the increase incidence and decrease mortality of end stage renal disease, there are more patients presenting for vascular access procedures. Although there has been a significant increase in the prevalence of fistulae in the United States over the last several years, many of these patients require central venous catheters during the fistula maturation process. The use of these catheters, along with the increase in the diameters of many of these catheters over the last several years, has likely played a significant role in the development of symptomatic central venous stenosis and occlusion. In this article the origin or central venous stenosis and occlusion will be reviewed along with a practical approach on how to best manage this disease process.
Altman
Sanford D
SD
Vascular Access Center, Inc., Miami, FL 33169, USA. sdaltm@attglobal.net
D017130:Angioplasty / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010690:Phlebography; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*