Characteristics of central vein stenosis patients at Abdoel Wahab Sjahranie Hospital Samarinda

ABSTRACT


INTRODUCTION
The current therapy for CKD that is considered optimal and widely used in developing countries is renal replacement therapy or hemodialysis (HD).CVS can happen because of indwelling cardiac wire, upper extremity peripherally inserted central lines, and central venous catheter in the vein. 4In using a central venous catheter (CVC), CVS is a common complication in HD patients. 3CVC placement can be inserted through the jugular, subclavian, and femoral veins.Clinical manifestations include pain; superior extremities and facial edema; dilatation of collateral veins in the face, neck, and chest; tissue damage and ulceration. 5The incidence of CVS in the population routinely undergoing HD is 14% in the United States, and in Canada is 23%-29%, but the data have not been obtained in Indonesia. 6he risk factors for CVS include the location of the CVC, the type and material of the catheter, the length of time the catheter was inserted, a history of the previous CVC placement, and a long duration of catheter insertion (> 6 weeks).The use of intravascular access or CVC as HD access mostly causes peripheral venous hypertension, which is related to the process of CVS. 1,7,8he diagnosis of symptomatic CVS can be established by anamnesis and physical examination in the form of enlargement of the arm circumference both subjectively and based on the examination of the arm circumference.In addition, supporting examinations in the form of Doppler ultrasound and venography can also assist in establishing the diagnosis.Venography can determine the location and length of stenosis.Once diagnosed, the treatment for CVS is venoplasty. 1 This study aims to evaluate the characteristics of patients with central venous stenosis in Abdul Wahab Sjahranie Hospital, Samarinda.

METHODS
This study is a cross-sectional descriptive study.The study was conducted by collecting data based on medical records data of CVS patients at Abdul Wahab Sjahranie Hospital between January 2018 to August 2021.The data was used to provide a demographic description and characteristics of CVS patients.
The inclusion criteria in this study were subjects diagnosed with upper central venous stenosis (subclavian vein, internal jugular vein, brachiocephalic/innominate vein, and superior vena cava) with a history of using hemodialysis access.Exclusion criteria in this study were CVS patients under the age of 30 years and patients with incomplete medical record

ORIGINAL ARTICLE
data.Analysis of the data in this study was using Microsoft Excel 2010.The data was analyzed in descriptive form and displayed in a table.

RESULTS
The total samples were 39 patients.Sixteen subjects were excluded due to incomplete medical report data.The total subjects who met the study requirements were 23 patients.Characteristics of assessment in CVS include sex, age, complaints, location of the stenosis, type of occlusion, and the angioplasty result are presented in Table 1 and Table 2.
The characteristics of the subjects are shown in Table 2.The most common clinical feature was swelling of the arms in as many as 19 (83%) subjects.The most frequent site of stenosis was in the subclavian vein in 20 (87%) subjects, with the left side being more frequent in 13 (57%) subjects.The most common type of occlusion was partial occlusion in as many as 16 (67%) subjects, with a single type in as many as 20 (87%) subjects.Success results of angioplasty reached 61% in 14 subjects.

DISCUSSION
Since 2018, the Thoracic, Cardiac, and Vascular Surgery Division of Abdul Wahab Sjahranie Hospital has started working on Venoplasty as therapy for CVS subjects.This study evaluates the characteristics of central venous stenosis in the population of Samarinda, particularly in Abdul Wahab Sjahranie General Hospital.The subject is a patient with CKD who has routinely undergone HD.Epidemiologically, most CKD patients (40%-60%) require HD twice per week and often have problems with inadequate venous access. 8In this study, 23 CVS subjects met the study requirements.CVS is the most common complication after HD catheter insertion in the central venous system.Several studies have stated that the incidence of CVS in patients with CVC placement can reach 19%, and the prevalence is up to 50%.However, the true prevalence and incidence of CVS are difficult to assess because a) CVS is often asymptomatic due to the increased blood flow caused by the formation of arteriovenous Fistula; b) Establishing an accurate diagnosis of CVS requires a venographic examination which is only performed when the patient shows clinical symptoms. 8n this study, the location of the most stenosis is in the subclavian vein, this is suspected to be due to the anatomical location that is more torturous than the internal jugular vein so that intraluminal blood flow turbulence is more frequent so that the risk of thrombosis formation is greater, and because the intraluminal surface is wider, it is more prone to endothelial injury. 1 Our findings are that CVS location is more common on the left side, although the selection of HD access sites is rarely made because generally permanent HD access with the arteriovenous shunt (AV Shunt) is performed on the non-dominant side if temporary and permanent venous catheter access is placed on the left side, it will increase the risk of CVS. 9, 10 From the Angioplasty procedure in 23 patients, it was recorded that 14 subjects were successful, whereas 9 patients failed, 7 of which were due to total occlusion,