Superior vena cava stenosis in tunneled cuffed catheters
There are two issues with superior vena cava (SVC) stenosis in patients with hemodialysis (HD) catheters: First, it may be a life-threatening complication, and second, there are currently no data available on prevalence and risk factors in HD patients.
Researchers at the Catholic University of Louvain in Belgium therefore undertook the present retrospective cohort study to assess prevalence and risk factors for SVC stenosis in HD patients with a tunneled cuffed catheter (TCC) (Labriola L et al, Superior vena cava stenosis in hemodialysis patients with a tunneled cuffed catheter: prevalence and risk factors. Nephrol Dial Transplant. 2018; doi: 10.1093/ndt/gfy150).
117 chronic HD patients with a total of 214 TCCs (equaling 80,911 catheter-days) were included in the study; SVC stenosis was defined as a diameter reduction of >50% on phlebography or CT. The authors recorded demographics, conditions potentially influencing catheter permeability (medications, use of thoracic devices), number of TCCs, total duration of TCC use, previous arteriovenous vascular access and last (in use at time of stenosis detection) TCC details (location, diameter and length).
9.4 percent of patients had a SVC stenosis (0.14/1000 catheter-days), which was almost 25 percent of all patients undergoing imaging for whatever reason (11/45). Only two patients presented with clinically obvious SVC stenosis. The number of TCCs per patient was 2.64 in the SVC stenosis group versus 1.75 in the negative group (P = 0.13). Two factors were associated with SVC stenosis: diabetes (incidence rate ratio [IRR] 4.63) and total duration of TCC use (IRR 1.47 per year). By contrast, age was found to have a slightly protective effect (IRR 0.96).
Nephrologists should be aware that SVC stenosis is not a rare condition, but that it is mostly asymptomatic in the absence of a peripheral vascular access. SVC stenosis has a strong association with diabetes and long TCC use, while age is slightly protective.