Brachiocephalic vein stenting and body-floss technique as a treatment of CVD in dialysis-dependent patient : case report and literature review

BACKGROUND: Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains. CASE REPORT: 61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by "body floss" technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self - expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center. CONCLUSIONS: Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical

Knowledge and prevalence of risk factors for coronary artery disease in patients after the first and repeated percutaneous coronary intervention

Background: Percutaneous coronary intervention (PCI) is an effective method for the treatment ofcoronary artery disease (CAD) that allows for a short hospital stay and fast recovery. It has been shown that PCI is a predictor of nonattendance at cardiac rehabilitation and correlates with poor adherence to lifestyle changes. Aims: The study was conducted to evaluate the influence of education offered during PCI‑related hospitalization on knowledge, awareness, and prevalence of self‑reported risk factors for CAD. Methods: We collected data using a self‑designed 56‑item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. The maximal knowledge score was 31 points and the maximal control score, 15 points. Results: The study group consisted of 200 consecutive patients undergoing PCI. Patients with a history of PCI performed at least 8 weeks prior to their current hospitalization were included in the prior‑PCI group (64%), whereas the pre‑PCI group comprised patients with no history of revascularization (36%). The median (interquartile range [IQR]) knowledge score was 19 (12.5–23) points in the pre‑PCI and 21 (12.5–24) points in the prior‑PCI group (P = 0.35). The median (IQR) risk control score was 5 (4.5–7) points in the pre‑PCI and 6 (4–8) points in the prior‑PCI group (P = 0.4). There was no correlation between the level of knowledge and the actual prevalence of CAD risk factors. We found that 50% of the prior‑PCI patients did not attend any rehabilitation, which correlated with poor control of CAD risk factors (P = 0.001). Conclusions: Currently used models of postprocedural education do not have an adequate effect on patient knowledge and do not bring recommended lifestyle changes