Asymptomatic Central Venous Stenosis in Hemodialysis Patients

Abstract

PTA of asymptomatic CVS greater than 50% in the setting of hemodialysis access maintenance procedures was associated with more rapid stenosis progression and escalation of lesions, compared with a nontreatment approach.

Paclitaxel-Coated Balloons for the Treatment of Symptomatic Central Venous Stenosis in Dialysis Access: Results from a Randomized Controlled Trial

“…Additionally, CVS treatment should be performed only in case the CVS becomes symptomatic. Treatment of a "silent" asymptomatic CVS could be associated with more rapid stenosis progression (23).…”

Effect of Central Venous Angioplasty on Hemodialysis Access Circuit Flow: Prospective Study of 25 Symptomatic Patients

“…Subclavian stenosis typically causes edema of the ipsilateral arm and/or breast, whereas brachiocephalic stenosis often causes ipsilateral neck or facial edema (3,5,6). Incidentally discovered asymptomatic CVS should not be treated because treating asymptomatic CVS can elicit more severe stenosis; only about 40% of asymptomatic CVSs worsen after 4 years (20)(21)(22).…”

Central Venous Stenosis Is More Often Symptomatic in Hemodialysis Patients with Grafts Compared with Fistulas

“…It is estimated that 25%-40% of patients with end-stage renal disease receiving hemodialysis have CVS (1), and this estimated prevalence has changed little since before the widespread transition from subclavian to jugular access for hemodialysis catheters (2). As a result of this high incidence, the focus in the literature has been on what can be done to treat CVS effectively and whether or not it is beneficial to treat CVS in asymptomatic patients (3)(4)(5)(6)(7)(8)(9).…”

“…The focus of the Centers for Medicare and Medicaid Services Fistula First Breakthrough Initiative (FFBI) has also been prevention, such as through avoidance of transvenous cardiac rhythm devices, in addition to reinforcing existing K/DOQI recommendations regarding avoiding subclavian catheterization and ideally avoiding catheters altogether (Fistula First Catheter Last [FFCL]). Among the main reasons that the emphasis in K/DOQI and FFBI has been on prevention are the relatively poor results associated with treatment of CVS, whether using percutaneous transluminal angioplasty (PTA), stents and stent grafts, or surgery (3)(4)(5)(6)(7)(8)(9).…”