In a second retrospective study by Ozyer et al in patients undergoing hemodialysis without CVCs, primary patency, marked by time from intervention to the subsequent intervention, was 24.5 months and 13.4 months, in the angioplasty and stent group, respectively [5,119]. Stents ought to be used cautiously or avoided regional to the thoracic outlet because of the associated risks for extrinsic compression and resultant stent fracture. In addition, the placement of stents over indwelling pacer or defibrillator wires may confound their removal. As such, consideration for their removal or for creation of a new AV access on the contralateral extremity when possible, may be given [5]. Placement of a New Tunneled Dialysis Catheter The presence of an appropriately positioned CVC in the internal jugular vein can result in a CVS even when the duration of placement is brief. Even peripherally inserted central catheters (ie, PICCs) are reported to precipitate a CVS or occlusion in as a high as 7% of cases with subclavian catheters provoking such stenotic lesions in up to 50% of cases [111]. Given that central venous stenoses or occlusions may represent the worst of the CVC-related complications, the KDOQI 2019 guidelines underscore the importance of limiting their use [5]. Considering the limitations of CVCs in precipitating or exacerbating central venous stenoses, there is no relevant literature to support the use of new tunneled dialysis catheter placement in the setting of a suspected CVS or occlusion, suggested by swelling of the extremity ipsilateral to the hemodialysis access. Continued Hemodialysis Access Use with Surveillance Mild symptoms associated with central venous stenoses, or occlusions may improve in time through the development of venous collaterals. As such, the presence of a central venous occlusion or stenosis may be marked by a functional AV access without associated arm edema in some patients [5].
Dialysis Fistula Malfunction. In a second retrospective study by Ozyer et al in patients undergoing hemodialysis without CVCs, primary patency, marked by time from intervention to the subsequent intervention, was 24.5 months and 13.4 months, in the angioplasty and stent group, respectively [5,119]. Stents ought to be used cautiously or avoided regional to the thoracic outlet because of the associated risks for extrinsic compression and resultant stent fracture. In addition, the placement of stents over indwelling pacer or defibrillator wires may confound their removal. As such, consideration for their removal or for creation of a new AV access on the contralateral extremity when possible, may be given [5]. Placement of a New Tunneled Dialysis Catheter The presence of an appropriately positioned CVC in the internal jugular vein can result in a CVS even when the duration of placement is brief. Even peripherally inserted central catheters (ie, PICCs) are reported to precipitate a CVS or occlusion in as a high as 7% of cases with subclavian catheters provoking such stenotic lesions in up to 50% of cases [111]. Given that central venous stenoses or occlusions may represent the worst of the CVC-related complications, the KDOQI 2019 guidelines underscore the importance of limiting their use [5]. Considering the limitations of CVCs in precipitating or exacerbating central venous stenoses, there is no relevant literature to support the use of new tunneled dialysis catheter placement in the setting of a suspected CVS or occlusion, suggested by swelling of the extremity ipsilateral to the hemodialysis access. Continued Hemodialysis Access Use with Surveillance Mild symptoms associated with central venous stenoses, or occlusions may improve in time through the development of venous collaterals. As such, the presence of a central venous occlusion or stenosis may be marked by a functional AV access without associated arm edema in some patients [5].