Search

For patients with repeated stenosis of autologous arteriovenous fistula, percutaneous transluminal angioplasty (PTA) or bare metal stent placement had limited efficacy. Rapamycin was reported to inhibit neointimal hyperplasia and keep blood vessels patent. In this study, we reported a case with refractory stenosis, i.e., a short duration of patency maintenance after each repeated PTA, which was treated with a rapamycin-eluting stent (RES). The RES extended the patency duration from 4 to 5 months on average to 14 months. The stent was used to maintain dialysis for over 30 months. RES may be an effective way to treat refractory stenosis and salvage limited vascular resources.

IntroductionSymptomatic pleural effusion is occasionally caused by superior vena cava syndrome. Dyspnea and pleuritic chest pain are common symptoms of pleural effusion. However, the current literature has not reported a causal linkage between chylous pleural effusion and dry cough.Case presentationA patient with uremia suffered from an unexplained severe dry cough, which could be triggered by postural changes. Medical examinations ruled out the possibility of chronic bronchitis, gastroesophageal reflux, chest tumor, tuberculosis, asthma, chronic obstructive pulmonary disease, and allergy history. Examinations showed that the patient had chylous pleural effusion. The cough symptoms were relieved after extraction of the pleural effusion but soon reappeared with the recurrence of chylothorax. Enhanced computed tomography showed that the patient had superior vena cava occlusion. After recanalization of the superior vena cava by percutaneous balloon dilatation, the patient no longer had chylothorax, and the severe cough was eliminated.ConclusionSuper vena cava syndrome can cause chylothorax and further stimulate severe dry cough. Cough is not a specific symptom. Chest imaging and pleural fluid analysis can help narrow down the diagnosis.

ObjectiveThe objective of the study is to present a case of hemodialysis in which the covered stent that had migrated into the right ventricle was retrieved by exploratory thoracotomy, and to review the literature on the diagnosis and treatment of stent migration in thoracic central vein obstruction (TCVO) procedures for hemodialysis patients.MethodA systematic search of the PubMed database was performed to identify clinical presentations, imaging strategies, stent types, and treatment modalities for stent migration in hemodialysis patients.ResultsA total of 14 case reports on stent migration in TCVO procedures for hemodialysis patients were included and analyzed. Ten cases included migration to the cardiac chambers and the remainder migration to the pulmonary artery. The common symptoms of stent migration in TCVO procedures are reported to be chest pain and dyspnea, while three of the cases studied involved no symptoms. Echocardiography, chest X-ray, and computed tomography are the commonly used methods for the diagnosis of stent migration and identification of the precise positioning of the stent. Stent migration to the right subclavian or innominate veins was the most prevalent case (seven cases). All were bare stents. Seven cases involved retrieval by interventional surgery, while four cases involved retrieval by open heart surgery. However, there were three cases in which the “wait-and-see” approach was adopted since the patients were asymptomatic.ConclusionsStent migration in TCVO procedures is a rare but extremely serious complication. The causes are not fully understood. The current treatment strategies include interventional surgery, open heart surgery, and the “wait-and-see” approach.