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Long-term follow-up of EVAR (mean, 7.5 years) revealed that approximately one in four patients will require intervention at some point during follow-up. First-time interventions were necessary in 22% of all patients in the first 5 years and in 6% of patients after 5 years, highlighting the need for continued graft surveillance beyond 5 years. All patients who had a first-time intervention after 5 years underwent an endoleak repair; none of these patients had a thrombosed limb or a rupture as a result of the endoleak.

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Data collection included demographics, medical histories, access history, subsequent procedures, and access usage.Results: We performed 19 medial claviculectomies in 19 patients with central venous stenosis. Eight accesses (42%) were created at another institution. Of those created at our institution, the average access age was 46.3 months. All patients previously underwent multiple angioplasty attempts and continued to have symptoms. Ten patients (53%) had previous subclavian stents placed. All patients underwent medial claviculectomy with venolysis and angioplasty. Twelve patients (63%) had residual stenosis requiring stent or stent graft placement. Three patients had subclavian rupture with angioplasty requiring stent graft placement. All patients reported symptom improvement, allowing for continued use of the access. Fourteen patients (74%) reported complete symptom resolution. Average length of follow-up was 9.5 months. Assisted primary and secondary patency at 1 year were 82% and 87%, respectively. One patient developed ischemic steal syndrome 5 months after medial claviculectomy and underwent a successful DRIL procedure.Conclusions: Medial claviculectomy is an effective treatment for recalcitrant central venous stenosis in patients with an ipsilateral hemodialysis access. Stent or stent graft placement is often necessary after extrinsic compression is alleviated.