Prevalence and Risk Factors of Central Venous Stenosis among Prevalent Hemodialysis Patients, a Single Center Experience.
BACKGROUND
Central vein stenosis (CVS) is a common complication of central venous catheter (CVC) insertion. In this study we evaluated the prevalence and risk factors of CVS among hemodialysis (HD) patients in a single center in Sudan, using Doppler ultrasound as a screening tool.


METHODS
The study included 106 prevalent HD patients. For every patient, we performed Duplex Doppler for the right and left jugular, subclavian and femoral veins. A patient was considered to have hemodynamically significant stenosis if the pre-stenosis to the post-stenosis velocities ratio was ≥ 2.5 or they had complete vein occlusion.


RESULTS
Overall, 28.3% of patients had Doppler detected CVS, including 25.5% with hemodynamically significant stenosis and 2.8% with compromised flow. The prevalence of CVS was 68.4% among symptomatic patients compared to 19.5% in asymptomatic patients. The prevalence of CVS among patients with history of 0-1, 2-3 and ≥ 4 central venous catheters was 3.4%, 29.4% and 53.8% respectively (p=0.00). CVS was not more common in patients with history of previous/current jugular or femoral vein catheterization compared to no catheter placement in these veins (28.3% vs 28.6% and 35% vs 26.7% respectively; p >0.1). However, CVS was significantly more common in patients with previous/ current subclavian vein catheterization compared to no catheter placement in this vein (47.8% vs 22.9%, p = 0.02).


CONCLUSIONS
CVS is highly prevalent among studied HD patients, particularly in the presence of suggestive clinical signs. The number of HD catheter placements and subclavian vein utilization for dialysis access impose a significantly higher risk of CVS.
Research fellow, Seven Corners Medical and Research Center, Arlington VA, USA.
Osama O
OO
Osman
Ahmed Gasim Cardiac Surgery and Renal Transplant Center, Khartoum, Sudan.
Abdul-Rahman A
AR
El-Magzoub
Ahmed Gasim Cardiac Surgery and Renal Transplant Center, Khartoum, Sudan.
Sarra
S
Elamin
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005268:Femoral Vein; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013350:Subclavian Vein; D013397:Sudan; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult