RESUMO
A common problem in the management of patients who are undergoing hemodialysis is central venous occlusive disease. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options to date include percutaneous balloon angioplasty, bare metal stents, and surgical bypass. Unfortunately, all the available treatment options have poor long-term patency, requiring repeated interventions. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There are very few data to date on this technology, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents, and covered stents. It appears that it is of paramount importance to prevent this difficult problem by limiting access to, or intervention in, the central venous system.
Assuntos
Prótese Vascular , Diálise Renal/efeitos adversos , Stents , Trombose Venosa Profunda de Membros Superiores/etiologia , Trombose Venosa Profunda de Membros Superiores/prevenção & controle , HumanosRESUMO
A common problem in the management of hemodialysis patients is central venous occlusive disease. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options to date include percutaneous balloon angioplasty, bare metal stents and surgical bypass. Unfortunately, all the available treatment options have poor long-term patency, requiring repetitive intervention. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There is very little data to date on this technology, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents and covered stents. It appears prevention of this difficult problem is paramount, by limiting venous access or intervention of the central venous system.
Assuntos
Angioplastia com Balão , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Diálise Renal , Doenças Vasculares , Veias , Angioplastia com Balão/instrumentação , Cateterismo Venoso Central/instrumentação , Constrição Patológica , Humanos , Prevalência , Desenho de Prótese , Recidiva , Stents , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , Doenças Vasculares/terapia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares , Veias/patologia , Veias/fisiopatologia , Veias/cirurgiaRESUMO
A major challenge in the management of hemodialysis patients is central venous stenosis and obstruction. Placement of central venous catheters has been shown to result in a high incidence of central venous stenosis or obstruction. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options include percutaneous balloon angioplasty and bare metal stents. Unfortunately, all the available treatment options have variable rates of patency, requiring repeated intervention. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There is very little data to date, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents, and covered stents. It appears prevention of this difficult problem is paramount, by limiting use of central venous catheters.