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Venous thoracic outlet syndrome and hemodialysis

Central venous stenotic disease is reported in 7%–40% of patients needing a central venous catheter for dialysis and in 19%–41% of hemodialysis patients who have had a prior central venous catheter. Half of these patients will be asymptomatic. Venous Thoracic Outlet syndrome in hemodialysis (hdTOS)...

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Autores principales: Davies, Mark G., Hart, Joseph P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10073697/
https://www.ncbi.nlm.nih.gov/pubmed/37035557
http://dx.doi.org/10.3389/fsurg.2023.1149644
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author Davies, Mark G.
Hart, Joseph P.
author_facet Davies, Mark G.
Hart, Joseph P.
author_sort Davies, Mark G.
collection PubMed
description Central venous stenotic disease is reported in 7%–40% of patients needing a central venous catheter for dialysis and in 19%–41% of hemodialysis patients who have had a prior central venous catheter. Half of these patients will be asymptomatic. Venous Thoracic Outlet syndrome in hemodialysis (hdTOS) is part of this spectrum of disease. The extrinsic mechanical compression of the subclavian vein at the costoclavicular triangle between the clavicle and 1st rib results in an area of external compression with a predisposition to intrinsic mural disease in the vein. The enhanced flow induced by the presence of a distal arteriovenous access in all patients exacerbates the subclavian vein’s response to ongoing extrinsic and intrinsic injury. Repeated endovascular interventions during the maintenance of vascular access accelerates chronic untreatable occlusion of the subclavian vein in the long term. Similar to patients with central venous stenosis, patients with hdTOS can present immediately after access formation with ipsilateral edema or longitudinally with episodes of access dysfunction. hdTOS can be treated in an escalating manner with arteriovenous access flow reduction to <1,500 ml/min, endovascular management, surgical decompression by first rib resection in healthy patients and medial clavicle resection in less healthy patients followed by secondary venous interventions, or finally, a venous bypass. hdTOS represents a complex and evolving therapeutic conundrum for the dialysis community, and additional clinical investigations to establish robust algorithms are required.
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spelling pubmed-100736972023-04-06 Venous thoracic outlet syndrome and hemodialysis Davies, Mark G. Hart, Joseph P. Front Surg Surgery Central venous stenotic disease is reported in 7%–40% of patients needing a central venous catheter for dialysis and in 19%–41% of hemodialysis patients who have had a prior central venous catheter. Half of these patients will be asymptomatic. Venous Thoracic Outlet syndrome in hemodialysis (hdTOS) is part of this spectrum of disease. The extrinsic mechanical compression of the subclavian vein at the costoclavicular triangle between the clavicle and 1st rib results in an area of external compression with a predisposition to intrinsic mural disease in the vein. The enhanced flow induced by the presence of a distal arteriovenous access in all patients exacerbates the subclavian vein’s response to ongoing extrinsic and intrinsic injury. Repeated endovascular interventions during the maintenance of vascular access accelerates chronic untreatable occlusion of the subclavian vein in the long term. Similar to patients with central venous stenosis, patients with hdTOS can present immediately after access formation with ipsilateral edema or longitudinally with episodes of access dysfunction. hdTOS can be treated in an escalating manner with arteriovenous access flow reduction to <1,500 ml/min, endovascular management, surgical decompression by first rib resection in healthy patients and medial clavicle resection in less healthy patients followed by secondary venous interventions, or finally, a venous bypass. hdTOS represents a complex and evolving therapeutic conundrum for the dialysis community, and additional clinical investigations to establish robust algorithms are required. Frontiers Media S.A. 2023-03-22 /pmc/articles/PMC10073697/ /pubmed/37035557 http://dx.doi.org/10.3389/fsurg.2023.1149644 Text en © 2023 Davies and Hart. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Davies, Mark G.
Hart, Joseph P.
Venous thoracic outlet syndrome and hemodialysis
title Venous thoracic outlet syndrome and hemodialysis
title_full Venous thoracic outlet syndrome and hemodialysis
title_fullStr Venous thoracic outlet syndrome and hemodialysis
title_full_unstemmed Venous thoracic outlet syndrome and hemodialysis
title_short Venous thoracic outlet syndrome and hemodialysis
title_sort venous thoracic outlet syndrome and hemodialysis
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10073697/
https://www.ncbi.nlm.nih.gov/pubmed/37035557
http://dx.doi.org/10.3389/fsurg.2023.1149644
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