Abstract
Purpose: To evaluate the clinical features and the survival benefits of Chinese hemodialysis (HD) patients with central vein stenosis (CVS) undergoing different treatments. Methods: From January 1, 2011 to Dec 31, 2012, 116 HD patients at high risk of CVS at our hospital had their bilateral central veins assessed by vascular ultrasound and conventional venography. We compared the clinical outcome of 24 non-treated asymptomatic, 17 non-treated symptomatic CVS and 6 treated symptomatic CVS. Treatment costs of CVS were recorded and patients’ survival rates were estimated by Kaplan-Meier analysis. Results: Among 116 patients, 47 were diagnosed with CVS. The timespan between symptomatic presentation and the diagnosis of CVS was more than 10 months averagely. Compared with non-CVS patients, the duration of HD in CVS patients was longer (33.8 ± 14.5 vs 1.1 ± 0.7 months) and the rate of central venous catheter (CVC) insertion was higher (87.2% vs 14.5%). Only 6 patients tried to maintain vascular access by endovascular intervention, the cost for which was $5210 per person, much higher than other treatment options. While 30 patients refused endovascular intervention for fear of re-stenosis risk and high treatment costs, among whom 28 lost their initial vascular access. The 12-month survival rates were 87.8%, 60% and 80.3%, respectively. The 24-month survival rates were 48.8%, 60% and 42.8%, respectively. No significant difference was found among the three groups. Conclusions: Endovascular intervention may not be the first choice for HD patients with CVS, considering long term survival benefit and high treatment cost.
Highlights
Central venous catheter (CVC) is often required as temporary or long-term vascular access for many HD patients in China
Clinical characteristics of patients with and without central vein stenosis (CVS) were shown in Table 1 116 out of 245 hemodialysis patients at our hospital were enrolled in the study. 6 patients without ipsilateral history of CVC or central venous operation were diagnosed with CVS; No CVS was found in 2 patients who presented arm edema ipsilateral to functioning arteriovenous fistula (AVF)
Clinical presentations of CVS in our patients were shown in Table 2. 11 patients presented facial swelling and/or unilateral upper limb edema; 8 of the 11 had ipsilateral functioning AVF (3 of the 8 patients had history of several ipsilateral AVF creations but no history of ipsilateral CVC or central venous operation); 3 of the 11 were patients with permanent hemodialysis catheter (PHC)
Summary
Central venous catheter (CVC) is often required as temporary or long-term vascular access for many HD patients in China It has been associated with an increased risk of CVS [1,2,3]. As HD patients live longer, we are facing a growing number of patients with CVS Endovascular intervention, such as percutaneous transluminal angioplasty (PTA) with or without stenting is recommended as the initial intervention for HD patients with CVS [4,5,6]. Their recommendations did not cover economic factors and survival benefits. Our purpose is to evaluate the clinical features and the survival benefits of Chinese HD patients with CVS undergoing different treatments
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