A retrospective cohort study comparing high and low balloon inflation pressure on technical success and patency for treating central venous lesions in patients on chronic hemodialysis

Abstract

Background We aimed to analyze the success rates and the access patency rates at 12 months between patients on chronic hemodialysis with symptomatic central venous stenosis (CVS) or occlusion (CVO), receiving high or low balloon inflation pressure for treatment. Methods We performed a retrospective study in which angioplasty balloons were inflated using a low-pressure or a high-pressure for the management of hemodialysis patients with CVS/CVO. The outcomes of this study were the success rate and the access patency rates at 12 months after balloon angioplasty, and the differences between groups were compared. Results We included a total of 74 patients on hemodialysis and assigned them to the low-pressure or the high-pressure groups. Success rates in patients of the high-pressure group (94.12%) were higher than those in patients of the low-pressure group (67.50%) ( p = 0.005). With a total of 59 patients with technical success, at 6 and 12 months after angioplasty, the rates of access patency in the low-pressure group were 68 and 48%, respectively; on the other hand, the primary patency rates in the high-pressure group were 86.67% (6-months) and 76.67% (12-months). The 6 and 12 months post-interventional patency rates were higher in patients of the high-pressure group than those in patients of the low-pressure group ( p = 0.10 at 6 months an d p = 0.03 at 12 months). Conclusions Compared to balloon angioplasty using a low inflation pressure, hemodialysis patients with CVS/CVO receiving angioplasty using a high inflation pressure have significantly higher technical success and 12-month patency rates.

Midterm Results of Tunneled Catheter Placement in Hemodialysis Patients with Central Venous Stenosis or Occlusion

“…The success rate was 100% in CVS, whereas for those with CVO, the success rate was 79%. This agreed with that achieved by Cui et al, 32 and Horita et al, 33 A series of retrospective investigations revealed that angioplasty for CVS and CVO has a technical success rate of 70% to 90%. The fact that we achieved a 100% success rate for CVS was owing to our objective of dilatation of the vein simply to the extent that enabled cuffed catheter passage, rather than setting a target of less than 30% stenosis.…”

Risk factors for blood vessel rupture during vascular access intervention therapy for hemodialysis patients

“…Other studies demonstrated no significant differences in rupture rates between low inflation pressures (10-14 atm) and high inflation pressures (24-30 atm) when dilating central venous stenosis in hemodialysis patients. Considering these facts, clinicians should not hesitate to inflate balloons to high pressures, which may lead to better patency rates [21,22].…”