Original Research

Central vein rupture during percutaneous transluminal angioplasty for central vein stenosis or occlusion in haemodialysis patients

Young J. Kim, Seung B. Yang, Woong H. Lee, Yong J. Kim, Jae M. Lee, Dong E. Goo, Beum J. Kim
South African Journal of Radiology | Vol 21, No 1 | a1205 | DOI: https://doi.org/10.4102/sajr.v21i1.1205 | © 2017 Young J. Kim, Seung B. Yang, Woong H. Lee, Yong J. Kim, Jae M. Lee, Dong E. Goo, Beum J. Kim | This work is licensed under CC Attribution 4.0
Submitted: 26 April 2017 | Published: 26 October 2017

About the author(s)

Young J. Kim, Department of Radiology, Presbyterian Medical Center, Seonam University College of Medicine, South Korea
Seung B. Yang, Department of Radiology, Soonchunhyang University Hospital, Gumi, South Korea
Woong H. Lee, Department of Radiology, Soonchunhyang University Hospital, Gumi, South Korea
Yong J. Kim, Department of Radiology, Soonchunhyang University Hospital, Gumi, South Korea
Jae M. Lee, Department of Radiology, Soonchunhyang University Hospital, Bucheon, South Korea
Dong E. Goo, Department of Radiology, Soonchunhyang University Hospital, Seoul, South Korea
Beum J. Kim, Department of Radiology, Presbyterian Medical Center, Seonam University College of Medicine, South Korea


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Abstract

Background: Endovascular treatments such as percutaneous transluminal angioplasty (PTA) and stent placements are becoming the standard method in managing haemodialysis access failure. Venous rupture is the most common complication during endovascular procedures. Complications during endovascular treatments of central venous stenosis or occlusion have been rarely reported.

Objectives: To investigate the incidence and management of central vein rupture while performing PTA for central vein stenosis or occlusion in haemodialysis patients.

Method: Between 1998 and 2013, PTA was performed using various techniques in haemodialysis patients for central vein stenoses (n = 2437) and occlusions (n = 666). When the guide wire passed through the stenosis or the occlusion, PTA was performed regardless of the presence of a venous rupture. The incidence of central vein rupture was analysed using the chi-square test according to the gender, location, right versus left, presence of thrombosis and stenosis versus occlusion. Percutaneous management of central vein rupture was also evaluated.

Results: Central vein rupture occurred in 12 cases (0.39%). All ruptures occurred in the cases with occlusion. Only stenosis versus occlusion reflected a significant correlation (p < 0.001) with central vein rupture. Central vein ruptures were managed by low-pressure balloon tamponade (n = 2), stent/stent-graft (n = 5) and balloon-mediated haemostasis blocking venous inflow followed by the observation (n = 5).

Conclusion: Central vein rupture is a rarely occurring complication while performing PTA for central vein stenosis and occlusion, and the majority can be successfully managed by percutaneous techniques.


Keywords

PTA; central vein; Hemodialysis

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