无血液透析插管史的中心静脉狭窄五例临床分析

目的 探讨无血液透析（血透）插管史的中心静脉狭窄患者的造影表现及诊治经验。 方法 回顾性分析上海交通大学医学院附属仁济医院2006年7月至2008年7月收治的5例无血透插管史的中心静脉狭窄的病例临床资料。 结果 女3例,男2例,年龄43~65岁,平均（53±8）岁;5例均表现为上肢肿胀;5例均为左腕部自体动静脉通路,平均建立时间（33.6±35.4）个月。静脉造影显示闭塞性病变2例,狭窄3例,其中头臂静脉狭窄1例,头臂静脉、锁骨下静脉各一处狭窄1例,锁骨下静脉双处狭窄1例。头臂静脉狭窄部位较恒定,均位于气管前方部位,CT显示局部受主动脉压迫。采用经皮血管腔内血管成形术（PTA）、锁骨下静脉-对侧锁骨下静脉旁路术、血透通路关闭术治疗后,症状缓解。 结论 高流量的动脉血流加剧了中心静脉潜在受压部位或瓣膜部位的内膜增殖,可能是导致无插管史的中心静脉狭窄的病因。静脉造影是首选诊断方法。治疗的远期疗效尚待进一步探讨。     

Simple formulas to determine optimal subclavian central venous catheter tip placement in infants and children

Background/Purpose

Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children.

Methods

We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA).

Results

Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA + 7 cm, and for the right subclavian vein approach it was 5*BSA + 6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children.

Conclusion

The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA.     

Epidemiology of vascular access and complications in patients undergoing maintenance hemodialysis in Tianjin

Objective To investigate the use of vascular access and complication incidence in patients undergoing maintenance hemodialysis in Tianjin. Methods Patients undergoing maintenance hemodialysis in the third level of first-class hospital in Tianjin were investigated. The investigate method was live interview. Two thousand six hundred and fifty-one cases were available. Basic data, age of dialysis, type of vascular access, age of vascular access and complications were recorded. The differences in clinic data and complications between patients using arteriovenous fistulas (AVF) and central venous catheter (CVC) as vascular access were compared. Results There were 2047 (77.22%) patients using AVF as vascular access, 559 (22.59%) patients using tunnel type central venous catheter, and 5 (0.19%) patients using arteriovenous graft (AVG) for maintenance hemodialysis. Most patients used temporary catheter as the first vascular access [2484(93.70%)]. Compared to AVF, CVC had high incidence of thrombosis and infection in the first four years (P=0.003). Conclusions AVF remains the first choice for maintenance hemodialysis. Most patients use AVF as their vascular access. The second preferred choice is CVC. The management of late chronic kidney disease should be enhanced to avoid the high usage of temporary catheter.     

Fourteen years of hemodialysis with a central venous catheter: mechanical long-term complications

The ideal dialysis access ensures adequate blood flow for dialysis, has a long life, and is associated with a low complication rate. Although no current type of access fulfills all these criteria, the native arteriovenous fistula (AVF) is close to doing so. Unfortunately, various kinds of vascular access (VA) are becoming more and more necessary to enable hemodialysis (HD). The central venous catheter (CVC), which is associated with higher morbidity and mortality, could be the only viable option to maintain permanent VA. We report an unusual complication in a patient, a 74-year-old female, who had been undergoing HD via a CVC for 14 yrs. A polyurethane CVC with a double lumen was inserted into the right internal jugular vein because an AVF was not feasible, and a polytetrafluoroethylene (PTFE) prosthesis was obstructed. In 2003, the CVC was removed due to stenosis and occlusion of the superior vena cava. A new CVC, also made of polyurethane and with a double lumen, was inserted into the left femoral vein. In January 2005, the patient reported a small rupture of about 3-4 mm located under the cuff of the CVC. For this reason, the left femoral vein had to be used, replacing the Optiflow one with a 40-cm long Tesio CVC, and the second catheter was inserted into the right femoral artery by conventional surgery. After 10 months, the patient returned once more, after the CVC in the left femoral vein had been removed because of malfunction and that the at-tempts to cannulate the same vein again had failed. Currently, two 70-cm long Tesio catheters implanted in the right femoral vein (whose tips almost reach the diaphragm) are used for dialysis sessions. The number of CVC implants has progressively increased amongst HD patients who are elderly, diabetic or who have been on long-term HD. The patient described in this case report is currently using a 70-cm long double Tesio catheter (single Tesio CVC in SPI silicon) placed in the right femoral vein. She has resumed therapy with dicumarol anticoagulants, maintaining INR within the 2.5-3.5 range. In conclusion, both the increase in the use of venous catheters for HD and in the survival of dialysis patients contribute towards the observation of rare complications associated with CVC use.     

Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access

To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All 14 patients had had bilateral temporary subclavian vein dialysis catheters and failed upper extremity arteriovenous access. Seventeen lesions were treated in 14 patients including eight subclavian vein occlusions, six subclavian vein stenoses, two internal jugular vein stenoses, and one superior vena cava stenosis. Twenty-one procedures were performed including 17 percutaneous transluminal balloon angioplasties (PTAs) with stent placement in 13, two axillary to innominate vein bypasses, and two axillary to internal jugular vein bypasses. All patients had resolution of symptoms. Thirteen (76%) PTAs were initially successful but in four (24%) cases it was impossible to recanalize the vein. Eight (47%) PTAs provided functional hemodialysis access for 2 to 9 months, two (12%) restenosed at 3 and 10 months and were successfully redilated, two occluded at 2 and 4 months and were unable to be recanalized, and one failed immediately after a successful PTA. Four PTA failures were followed by venous bypass, which remained patent and provided functional access 7 to 13 months after surgery. Of nine stenotic venous lesions six (67%) were successfully dilated without restenosis, whereas of eight occluded veins only two (25%) were successfully treated without recurrence. Temporary central hemodialysis catheters produce a significant number of symptomatic central vein obstructions in patients with upper extremity arteriovenous access. PTA with stenting and venous bypass provides early success in most patients. Transcatheter therapy is less successful in treating complete venous occlusions when compared with stenotic lesions. All effort should focus on preventing this complication by avoiding the use of temporary subclavian vein hemodialysis catheters.     

Catheter malplacement during central venous cannulation through arm veins in pediatric patients

For successful catheter placement, central venous cannulation (CVC) through internal jugular vein and subclavian vein has been recommended in both adult and pediatric patients. But it carries a risk of serious complications, such as pneumothorax, carotid, or subclavian artery puncture, which can be life-threatening, particularly in critically ill children. So a prospective study was carried out to determine the success rate of correct catheter tip placement during CVC through antecubital veins in pediatric neurosurgical patients. A total of 200 pediatric patients (age 1-15 years) of either sex were studied. Basilic or cephalic veins of either arm were selected. All the patients were cannulated in the operation room under general anesthesia. Single lumen, proper size catheters (with stillete) were used for cannulation. The catheter was inserted in supine position with the arm abducted at right angle to the body and neck turned ipsilaterally. The length of insertion was determined from cubital fossa to the right second intercostal space. The exact position of the tip of the catheter was confirmed radiologically in ICU. Correct catheter tip placement was achieved in 98 (49%) patients. Multivariate logistic regression analysis of data shows that there was no statistically significant difference among correct and incorrect catheter tip placement in relation to factors including sex, side of cannulation (left or right), and type of vein (basilic or cephalic). The analysis of correct catheter tip placement in relation to age showed that the highest success rate was achieved in children of age group 6 to 10 years (60.2%) followed by 30.6% in the 11 to 15 year group. The lowest success rate of tip placement of only 9.2% was observed in younger children of age 1 to 5 years, which is statistically significant (P = 0.001). Of 102 incorrect placements reported, 37% were in 1 to 5 year age group versus 9.2% correct tip placements. The most common unsatisfactory placements were either in the ipsilateral internal jugular vein (N = 38, 37.2%) or in the ipsilateral subclavian vein (N = 27, 26.4%). In 10 patients the catheter crossed over to the opposite subclavian vein, in 16 patients the catheter tips were found in the axillary vein, and in 10 patients each the catheter tip was observed in right atrium and right ventricle. No major complication during and following CVC was observed. To conclude, CVC using single orifice catheter through arm veins in pediatric patients is easy to perform, but the proper catheter tip placement is highly unreliable, particularly in younger children 1 to 5 years of age.     

The Incidence of Subclavian Vein Stenosis Using Silicone Catheters for Hemodialysis

Abstract: Complications related to the use of silicone subclavian catheters for hemodialysis were prospectively studied in 21 consecutive patients with acute and chronic renal failure. Between July 1991 and December 1992, 34 double-lumen silicone catheters (Medcomp; 12 French; 20 or 24 cm) were inserted in 21 patients. The mean duration of catheterization was 20 days (range, 2–58 days). Venograms were performed in 16 patients (22 subclavian veins) within 6 months following removal of the catheter. Excluded from angiography were patients whose catheters had been in place less than 1 week or who underwent fewer than 3 dialysis sessions because of minor risk of stenosis. Patients who had ipsilateral repeated catheters were also excluded. Two angiographies showed subclavian vein stenosis, both occurring in the same patient. One showed 50% stenosis with collaterals; one showed 50% stenosis without collaterals. One other complication was a pneumothorax. Catheter thrombosis was observed in 3 patients; catheter sepsis did not occur. We conclude that use of silicone catheters for subclavian cannulation is safe and effective to provide temporary vascular access for acute hemodialysis. The incidence of subclavian vein stenosis is lower compared with polytetrafluoroethylene and polyurethane catheters.     

Cost-effect analysis of endovascular intervention to central vein stenosis in hemodialysis population

Objective 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 in Wuhan Central Hospital had their bilateral central veins assessed by vascular ultrasound and conventional venography. The clinical outcomes of 24 non-treated asymptomatic CVS patients, 17 non-treated symptomatic CVS patients and 6 treated symptomatic CVS patients were compared. 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 time span 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) months vs (1.1±0.7) months, P﹤0.01] and the rate of central venous catheter (CVC) insertion was higher (87.2% vs 14.5%, P﹤0.01). Only 6 patients tried to maintain vascular access by endovascular intervention which costed ￥33 500 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 patients lost their initial vascular access. The 12-month survival rates of non-treated symptomatic CVS patients, treated symptomatic CVS patients and non-treated asymptomatic CVS patients were 84.6%, 88.9% and 87.0%, respectively, and the 24-month survival rates were 38.5%, 61% and 53.9%, respectively. No significant difference was found among the three groups. Conclusions Endovascular intervention may not be the first choice, but an alternative choice for Chinese HD patients with CVS, considering the long term survival benefit and the high treatment cost.     

Long-term central venous catheters: size and location do matter

BACKGROUND: Right or left side of placement for subclavian vein catheterization for placement of long-term central catheters and size of the catheters has not been analyzed completely. METHODS: The records of 502 consecutive long-term central venous catheters placed in patients while in the operating room over a 1-year period were reviewed and 230 subclavian vein tunneled catheters were analyzed. Technical difficulties in placing the catheters were defined as arterial puncture, guidewire malposition, catheter malposition, need to switch site of access, sheath difficulty, and inability to place the catheter. RESULTS: Three complications were identified (1%) and technical difficulties occurred in 15% of the patients. More difficulty was associated with the insertion of larger triple-lumen catheters than smaller single-lumen catheters (31% vs. 11%, respectively; P < .009). Right subclavian placement was associated with a 24.4% technical difficulty rate versus a 10.4% technical difficulty rate for left subclavian placement (P < .005). CONCLUSIONS: This study supports placing the smallest catheter necessary via the left subclavian vein.     

Hemodialysis Catheter‐Associated Central Venous Stenosis

The purpose of this review is to explore the pathophysiology, epidemiology, and interventional treatment of central vein stenosis (CVS) that may result from central vein catheter (CVC) placement. The precise mechanism of CVC‐associated CVS remains largely undefined, though anatomic considerations appear to play a prominent pathologic role. The impact of CVC‐associated CVS on arteriovenous fistula outcomes is reviewed. The percutaneous treatment of CVS, observation, angioplasty, or angioplasty with stent placement is reviewed, along with potential surgical treatment options. As the treatment outcomes of CVC‐associated CVS have been disappointing, catheter avoidance remains the best strategy.     

Late development of hydrothorax induced by a central venous catheter: Report of a case

We report herein the case of a 47-year-old woman who suffered a hydrothorax induced by a central venous catheter (CVC) which had been placed to facilitate total parenteral nutrition following a left sleeve pneumonectomy for lung cancer. The CVC was inserted into the superior vena cava (SVC) through the left subclavian vein after the operation; however, the tip inadvertently turned upward and came in contact with the lateral wall of the SVC. The patient suddenly developed dyspnea due to a right-sided hydrothorax 47 days after the insertion of the catheter. Indocyamine green administered through the catheter was thereafter found in the pleural fluid. The continuous mechanical force of the catheter tip against the SVC wall was thus considered to be the cause of this life-threatening delayed hydrothorax.     

Magnetic resonance venography in assessing venous patency after multiple venous catheters

Background/Purpose: Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of the study was to assess the value of magnetic resonance venography (MRV) in assessing venous patency in children with suspected venous thrombosis. Methods: Contrast studies through the CVC (linogram) and Doppler ultrasonography were the initial investigations performed in children with suspected CVC-related thrombosis. Two-dimensional gated inflow and phase contrast MRV also was performed to assess the extent of venous thrombosis and to locate patent veins for replacement CVC. When the MRV identified a suitable patent vein, the CVC was reinserted by direct venous cut down or the percutaneous method under a general anaesthetic. Results: A total of 25 children (median age, 5 years; range, 2 months to 17 years) who had multiple CVC insertions (median, 3; range, 1-9), underwent MRV for suspected venous thrombosis. Of 10 patients in whom the catheter was completely occluded, MRV identified extensive thrombosis of the central veins in 6. In 7 other children the linogram showed adherent thrombus at the tip of the CVC only. In 5 of these 7 children MRV showed extensive thrombosis of the vein in which the catheters were placed. Doppler ultrasonography diagnosed thrombotic occlusion of the neck veins in 7 children. The MRV studies showed more extensive thrombosis in 4 of these 7 patients. Additionally, MRV showed thrombosis of the intrathoracic veins in 11 patients who had patent neck veins on ultrasound scan. MRV identified a patent vein for reinsertion of CVC in 22 of 25 children. At operation, venous patency was confirmed in 20 patients (91%). Conclusion: MRV in children with suspected CVC-related thrombosis is more accurate than Doppler ultrasonography, and contrast studies for defining the extent of venous thrombosis. MRV correctly shows venous anatomy and patency for reinsertion of CVC.     

Estimation of central venous pressure by measurement of proximal axillary venous pressure using a "half-way" catheter

The pressure in the proximal axillary vein (AVP) was compared with central venous pressure (CVP) in eight patients during and after elective abdominal surgery. Both pressures were recorded from soft, elastic, polyurethane catheters inserted in the basilic or cephalic veins ("half-way" catheters), punctured at the fossa cubiti (AVP), and via the right jugular vein (CVP). The AVP and CVP were recorded simultaneously using hydrostatic, conventional disposable venous pressure measurement sets. The measurements were performed during intermittent positive pressure ventilation with positive end-expiratory pressure from 0 to 7.5 cmH2O (0-0.74 kPa), as well as during spontaneous breathing. During both controlled and spontaneous respiration, small mean differences (0.2-1.0 cmH2O) (0.02-0.1 kPa), and a highly significant (P less than 0.001) positive correlation between CVP- and AVP-values were found. An increase of 1 cmH2O (0.10 kPa) in the CVP was associated with an increment of practically identical order (0.99-1.04 cmH2O) (0.10-0.11 kPa) in the AVP. The results suggest that monitoring of the AVP by a basilic "half-way" catheter produces diagnostic information similar to that from the measurement of the CVP from subclavian, external or internal jugular, as well as "long-way" brachial catheter, with no risk of the major mechanical complications which accompany the use of the latter catheters.     

Central venous catheter-induced delayed hydrothorax via progressive erosion of central venous wall

Central venous catheter (CVC)-induced hydrothorax is a delayed complication after the placement of an indwelling subclavian or internal jugular central venous catheter. The catheter tips may cause long-lasting mechanical damages that lead to a slow erosion of the wall of the superior vena cava (SVC), thereby resulting in hydrothorax. The damage may stem from the catheter tips being positioned inappropriately or from the relocation of the catheter tip that was initially ideally positioned. We describe an 80-year-old woman with CVC-induced hydrothorax. She presented with spinal subdural hematoma and preoperatively underwent a multiple-lumen CVC insertion through her left subclavian vein. Her recovery course was uneventful after surgical hematoma removal and spinal cord decompression. However, thirty hours after the CVC placement, the patient began to suffer from an increasing dyspnea. The chest X-ray showed right-sided, massive pleural effusion and a widened mediastinum, requiring the removal of the CVC and the drainage of the pleural fluid. After these procedures, the respiratory status improved rapidly. The present case report suggests that the complication of a hydrothorax may occur after a patient's position changes, and it usually occurs in cases where the catheter tip was initially placed in the ideal position. Operators responsible for CVC placement have to be aware of this delayed complication and have the catheter tips remain in a consistently appropriate position.     

Combined endovascular and surgical recanalization after central venous catheter-related obstructions

Central venous occlusion in children is a challenging problem that can occur after a central venous catheter insertion. Long-term catheter-related complications include sepsis and venous thrombosis with consequent loss of central access. We describe 2 cases of children younger than 1 year who were dependent on a central venous catheter for total parenteral nutrition. They developed a chronic extensive obstruction of the right and left brachiocephalic veins with a superior vena cava syndrome. The patients' survival was dependent on the restoration of central venous access until the planned intestinal transplantation could be performed. Retrograde recanalization of the superior vena cava was successfully achieved using a pathway created under general anesthesia from the femoral vein to, respectively, the right thyroid vein and the right subclavian vein.     

The use of multi-detector computed tomography venography and three dimensional reconstruction image in evaluating the central venous occlusive disease of hemodialysis patients

Objective To evaluate the feasibility and value of multi-detector computed tomography venography (MDCTV) and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients, and in the value of guiding interventional treatments. Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multislice spiral computed tomography (128-MSCT) and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s. MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold, with the monitoring?point?set in the development of the lumen of inferior vena cava, to detect the position and degree of vascular stenosis. The images were reformed as maximum intensity projection (MIP), volume rendering (VR), curved planar reformation and three-dimensional image reconstruction technique. Results MDCTV clearly demonstrated the lesion location in all cases enrolled. Seventy-five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV, of which the lesions of brachiocephalic vein was 47, superior vena cava 15 and subclavian vein 13. Among the 75 stenosis lesions, the number of complete occlusive, severe, moderate and mild stenosis was 31, 24, 19 and only 1, respectively. MDCTV provided information coincident with that of digital?subtraction?angiography (DSA), which the correlation index was 0.401, while DSA showed that number of complete occlusive, severe, moderate and mild stenosis was 49, 7, 14 and 5, respectively. Percutaneous transluminal angioplasty was performed in 53 patients, and stent placement was done in 40 patients. After interventional treatments, swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to?the?extent?that?they could meet the requirement of hemodialysis. Conclusions MDCTV is the first choice to evaluate the condition of central?venous?occlusive diseases of hemodialysis patients with advantages of non-invasion, high definition and three-dimensional?reconstruction. It can provide accurate evaluations of the conditions of occlusive lesions, which can be of great clinical significance to subsequent interventional therapy.     

Is a routine chest x-ray necessary for children after fluoroscopically assisted central venous access?

Purpose: The aim of this study was to determine in a pediatric population whether a routine chest x-ray after central venous access is necessary when the central venous catheter is placed with intraoperative fluoroscopy.Methods: This was a retrospective review of the charts of all patients at Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, sex, primary reason for access, access site, number of venipuncture attempts, type of catheter, intraoperative fluoroscopy results, chest x-ray results, location of the tip of the catheter, and complications were analyzed.Results: There were 1,039 central venous catheters placed in 824 patients, 92.6% in the subclavian vein and 7.4% in the internal jugular vein. There were 604 (58.1%) children who had both fluoroscopy and a postprocedure chest x-ray, there were 308 (29.6%) who had only fluoroscopy, there were 117 (11.3%) who had only a postprocedure chest x-ray, and there were 10 (1.0%) who had neither fluoroscopy nor chest x-ray. On completion of the procedure, there were 12 (1.1%) children with misplaced central venous catheters, only 1 (0.1%) when intraoperative fluoroscopy was used. There were 17 (1.6%) complications; 9 (0.9%) were pulmonary (pneumothorax, hemothorax, or an effusion). All children with pulmonary complications experienced clinical signs and symptoms suggestive of the complication after their central venous catheter insertion but before their postprocedure chest x-ray.Conclusions: The number of complications encountered in children who had central venous access of the subclavian vein or internal jugular central vein with intraoperative fluoroscopy was infrequent, the number of misplaced catheters was minimized with intraoperative fluoroscopy, and all children with pulmonary complications showed clinical signs suggestive of pulmonary complications before postoperative chest x-ray. Therefore, children who have had central venous access of the subclavian and internal jugular vein with intraoperative fluoroscopy do not appear to require a routine chest x-ray after catheter placement unless clinical suspicion of a complication exists.     

Central venous access via the external jugular vein in cardiovascular surgery

In 115 consecutive adult patients scheduled for cardiovascular surgery, 150 catheterizations of the innominate or superior caval veins via an external jugular vein were attempted. The Seldinger technique was employed. In 99 (96-100)% of the attempts a straight, J-modified straight or a J-wire could be passed into the central venous system. One hundred and forty-six (97 (93-99)% of the subsequent catheter insertions were successful. Thirty-five patients had bilateral catheter insertions. Both sides proved to be equally suitable. Six anesthetists participated in the study and the longest catheterization time was 16 min. All catheterization procedures were uncomplicated.     

血液透析患者中心静脉狭窄的临床特点、血管腔内治疗的效果观察

目的 探讨血液透析患者中心静脉狭窄(central vein stenosis,CVS)的临床特点以及对其实施血管腔内治疗的临床疗效.方法 选取2012年1月至2014年1月于本院行血液透析治疗且合并有中心静脉狭窄的36例患者为研究对象,采用静脉造影技术,分析其临床特点,并对其实施血管腔内治疗,观察其治疗效果.结果 本组患者包括27例中心静脉狭窄与9例中心静脉闭塞.其中,狭窄位于右侧锁骨下静脉与头臂静脉交汇处13例(36.11%),左侧头臂静脉近心端8例(22.22%),右侧头臂静脉近心端4例(11.11%),右侧腋静脉伴锁骨下静脉2例(5.56%);闭塞位于左侧头臂静脉4例(11.11%),右侧锁骨下近端5例(13.89%).36例患者中有24例行经皮血管支架植入术(pecutaneous transtuminl stenting,PTS)或经皮血管球囊扩张成形术(pecutaneous transtuminl angioplasty,PTA)联合治疗,其余12例行PTA治疗,治疗1周后患者上肢、腋部与胸壁浅表静脉曲张缓解或消失;随访期间有6例患者复发,且均为行PTA治疗的患者.结论 掌握中心静脉狭窄的临床特点,有助于患者的早期诊治,对预后具有重要意义;血液透析合并中心静脉狭窄患者行单纯PTA或PTS与PTA联合治疗,均可取得较好的治疗效果,但PTA治疗后复发的可能性较高.     

A Central Venous (W-B-W) Catheter for Multipurpose Vascular Access in Children

A central venous (W-B-W) catheter has been developed for vascular access in children of all ages and sizes. The catheter design and implantation technique permit nonsurgical bedside adjustment of catheter position and ease of removal. Multiple possible uses include intravenous fluid administration, blood sampling, central venous pressure monitoring, and plasma exchange therapy in addition to hemodialysis. Twenty-seven W-B-W catheters were placed in 24 patients in a 12-month period. The catheter provided adequate blood flow for hemodialysis. Seven catheters were removed nonelectively in five patients. One episode of catheter-associated sepsis occurred after renal transplantation in a patient on immunosuppressive therapy. It is concluded that the W-B-W catheter is a relatively safe, multipurpose, pain-free acute vascular access for children, which may also suffice for chronic hemodialysis.