Objective To preliminarily evaluate the feasibility and safety of percutaneous sharp recanalization of the superior vena cava (SVC) with puncture instruments assistance followed by catheter placement in hemodialysis patients with exhausted central venous access resources. Methods A retrospective analysis was conducted on clinical data of hemodialysis patients who underwent RUPS-100-assisted sharp recanalization at West China Hospital, Sichuan University between March 2019 and August 2024. All patients were diagnosed with SVC occlusion via digital subtraction angiography or computed tomographic angiography and conventional guidewires and catheters failed to traverse the occlusive lesions as judged by operators. The technical success rate, perioperative complications, post-procedure blood flow volume, and catheter patency rate were recorded. Results A total of 17 patients were enrolled, among whom sharp recanalization was successfully performed in 14 cases, corresponding to a technical success rate of 82.4%. The mean length of recanalized occlusive segment was (2.2±0.5) cm, and the mean procedural time was (73.4±9.5) minutes. One patient developed intraoperative hemopericardium (Society of Interventional Radiology adverse event grade C), which improved under close monitoring and conservative management without progression to cardiac tamponade. The post-procedure blood flow was maintained above 240 mL/min in all successfully recanalized patients. The primary patency rates at 6 months and 12 months were 92.9% and 66.7%, respectively. Conclusions RUPS-100-assisted sharp recanalization is an effective and acceptably safe salvage procedure for the treatment of SVC occlusion in hemodialysis patients, offering a novel therapeutic option for patients with refractory vascular access dysfunction. Given the limitations of its retrospective, single-center and small-sample design, further large-scale studies are required to validate these findings.
Objective To investigate the clinical effect and safety of balloon angioplasty (BAP) for patients with venous hypertension associated with autogenous arteriovenous fistula (AVF). Methods Thirty-three patients with venous hypertension associated with AVF were hospitalized between August 2012 and August 2014 in the Department of Nephrology, West China Hospital of Sichuan University. All of the patients received BAP therapy. The clinical characteristics and therapeutic effects were comparatively summarized before and after operation. Results Venous hypertension in all the 33 patients was caused by central venous stenosis or occlusion. Among them, there were 13 cases of stenosis on the site where the left innominate vein crossed the aorta, 10 cases of stenosis at the junction of the left innominate vein and superior vena cava, 4 cases of stenosis at the junction of the left subclavian vein and the innominate vein, 3 cases of right innominate vein stenosis, and 3 cases of innominate vein occlusion. The lesions were most common in the innominate vein. Innominate vein stenosis or occlusion occurred in 19 cases (57.6%), and stenosis at the junction of innominate vein and the superior vena cava or subclavian vein occurred in 14 cases (42.4%). Of the 33 patients, one patient with complete occlusion of the innominate vein did not receive BAP treatment because guide wire could not pass through the occlusion site. The other 32 patients underwent BAP treatment, among whom 30 (93.8%) were successful, and 2 (6.2%) failed. No obvious complications occurred. One day after BAP treatment, patients’ symptoms were significantly relieved. One to seven days later, swelling of the hands, pain, and other symptoms were relieved. In the 30 patients who underwent the treatment successfully, 29 were followed up for 3 to 24 months. Among them, 21 (72.4%) maintained clinical remission and the AVFs were functional, 6 patients (20.7%) got a restenosis later, and 2 patients died. Conclusions BAP is effective and safe for venous hypertension associated with AVF. However, the follow-up of patients has displayed the possible risk of restenosis in long-term outcomes.
ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
ObjectiveTo study the clinical characteristics of elderly hemodialysis (HD) patients and discuss how to control their complications, in order to improve their quality of life and lower their mortality rate. MethodContrastive study and analysis were performed on the clinical data of 98 maintenance HD patients (between elderly and young HD patients) between January 2013 and January 2014. Complications, rate of hospitalization and mortality were analyzed during the follow-up of one year. ResultsThe ratio of hypertensive kidney disease and diabetic nephropathy, as primary disease of the elderly HD patients, gradually increased. More people chose to use semi-permanent jugular vein catheter for elderly HD patients. Compared with young HD patients, the levels of hemoglobin, albumin, serum creatinine, KT/v were lower in the elderly patients, and C-reactive protein was much higher (P<0.05). There was no significant difference in cholesterol, triglyceride, calcium, phosphorus, parathormone between the two groups (P>0.05). Dialysis-related hypotension and blocking of vascular access occurred more frequently in elderly HD patients. Hospitalization rate and mortality rate were higher in elderly HD patients (P<0.05). ConclusionsImproving nutritional status, keeping vascular access unobstructed for a long time and decreasing complications related to hemodialysis are helpful for elderly HD patients to enhance their quality of life and reduce the mortality rate.
Objective To analyze the results of the 2024 annual competency assessment of the Hemodialysis Vascular Access Intervention Technique Specialized Training Program, evaluate trainees’ current operational competence, identify weaknesses in the training system, and provide evidence for optimizing the training curriculum. Methods From August to September 2024, trainees underwent offline practical ultrasound examinations at two sites: Chongqing (southern region) and Shijiazhuang (northern region). The examination assessed functional evaluation of arteriovenous fistulas in real maintenance hemodialysis patients, including physical examination and ultrasound evaluation. domestic mainstream ultrasound systems were used, and faculty members conducted one-on-one proctoring. Anonymous questionnaires were administered to examiners and trainees after the examination. Common problems and learning needs were ranked and scored according to severity. Results A total of 223 trainees actually participated in the offline examination, with 17 faculty members supervising the test. Among the 223 trainees, 209 passed the examination, with a pass rate of 93.7%. Examiner survey results indicated that the most prominent common problem was poor ultrasound image quality (score ratio 80.15%), followed by failure to detect clinically significant stenosis during physical examination (69.12%) and unfamiliarity with ultrasound probe manipulation (64.71%). Enhanced practical ultrasound training was identified as the most urgent learning need. Trainee survey results revealed that the most difficult examination item was visualization and diameter measurement of the anastomosis (score ratio 67.94%), while the most significant adverse factor was unfamiliarity with the ultrasound machine brand and operating interface (91.03%). A total of 76.47% of examiners and 80.92% of trainees agreed that standardized operating procedures for arteriovenous fistula physical examination and ultrasound assessment should be established as soon as possible. Conclusions Notable deficiencies were observed in ultrasound image acquisition, accuracy of physical examination, and proficiency in equipment operation. It is recommended to establish standardized operating procedures promptly, strengthen practical ultrasound training and physical examination education, refine scoring criteria, and unify training materials to improve training quality and assessment uniformity.