Screening for Carotid Artery Stenosis and Renal Artery Stenosis in Patients Undergoing Tunneled Cuffed Hemodialysis Catheter Placement

Department of Surgery, Division of Vascular Surgery, Lutheran Medical Center, Brooklyn, NY 11219, USA.
Vascular and Endovascular Surgery (Impact Factor: 0.66). 07/2012; 46(5):364-8. DOI: 10.1177/1538574412449391
Source: PubMed


In this study, we noted the common risk factors with atherosclerosis and chronic renal disease. We, therefore, hypothesized that the placement of a dialysis catheter would be a useful marker in identifying populations at increased risk of vascular disease (carotid, renal, and aortic). To further explore this issue, we examined the results of duplex scanning of the carotid arteries and aortorenal arteries in patients undergoing dialysis catheter placement. Over 49 months, each of the 123 patients who underwent permanent tunneled dialysis catheter placement received a carotid duplex study. Twelve patients (9.8%) had ≥ 60% stenosis and 8 patients (6.5%) had 70% to 99% stenosis. Furthermore, 109 patients who underwent a aortorenal artery duplex study were also analyzed. The study population demonstrated a prevalence rate of 3.7% for abdominal aorta aneurysm (AAA) and 4.6% for renal artery stenosis (RAS). Based upon these data, we suggest performing routine carotid duplex scans in patients who will also receive dialysis catheter placement. However, the data did not support routine screening of AAA or RAS.

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    ABSTRACT: Objectives: We aimed to determine the prevalence of significant carotid stenosis in maintenance hemodialysis patients and to identify biochemical and echocardiographic predictors of significant carotid stenosis in those patients. Study design: One hundred and seventeen maintenance hemodialysis patients were included in this study. Echocardiography biochemical tests and carotid artery Doppler ultrasonography were performed in all patients. Data obtained from patients without severe carotid stenosis were compared with those obtained from patients with severe carotid stenosis. Results: The mean age of the patients was 56.9±12.2 years. Eleven patients had carotid artery stenosis (9.4%). While there was a trend of higher left ventricle end diastolic diameter in severe carotid artery stenosis (p=0.06), no statistically significant biochemical or echocardiographic differences were noted between the patients. Conclusion: This study demonstrated that the prevalence of carotid artery stenosis is 5-10- fold higher than in the general population. All patients in a chronic hemodialysis program should be screened for carotid artery stenosis for prevention of cerebrovascular diseases.
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