Medial claviculectomy for the treatment of recalcitrant central venous stenosis of hemodialysis patients

Auyang, Philip; Chauhan, Yusuf; Loh, Thomas M.; Bennett, Matthew E.; Peden, Eric K.

doi:10.1016/j.jvsv.2018.10.024

Cited by 15 publications

(5 citation statements)

References 23 publications

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“…Since heterogeneity in lesions of CVS/CVO exists, especially with regard to the site of external bony compression overlying the subclavian vein, whose feasibility for treatment creates concern. Some investigators suggested that the trimming of the first rib or clavicular bone surgery might facilitate a better treatment efficacy before PTA compared to PTA alone for subclavian vein [ 12 , 15 ]. However, in the present study, the 12-month post-interventional patency rates were still significantly higher in patients of the high-pressure group after lesions of the subclavian vein were excluded in both groups.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Gao

et al. 2021

Renal Failure

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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.

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Section: Discussionmentioning

confidence: 99%

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

Chen

Gao

et al. 2021

Renal Failure

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“…For symptomatic CVOD, treatment includes surgery (such as surgical bypass or medial claviculectomy) and EVT. EVT, which is less invasive than surgical bypass, with comparable short-term patency, is the preferred intervention [14][15][16][17] . However, EVT also has disadvantages, such as elastic recoil and restenosis after PTA, which seriously affect the quality of life of patients and increases medical expenses [5,18,19] .…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

liu,

wang,

wang

et al. 2024

Preprint

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Aim To assess the effectiveness and predictive factors of stent grafts (SGs) for the treatment of central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access. Methods HD patients with CVOD who underwent SGs at our center between August 2018 and June 2022 were enrolled. The Kaplan–Meier method and log-rank test were used for survival curve analysis. SGs. Results 59 SG implantation procedures for CVOD were analyzed using Cox proportional hazards regression for the predictive factor analysis. Thirty subjects had stenosis and 29 had occlusion. The access circuit primary patency (ACPP) after SG placement at 6, 12, and 24 months was 80.9%, 53.8%, and 31.4%, respectively. The target lesion primary patency (TLPP) after SG placement at 6, 12, and 24 months were 91.3%, 67.6%, and 44.5%, respectively. In the subgroup analysis, the TLPP was higher in the stenosis group than in the occlusion group, but the difference was not significant (P = 0.165). The TLPP of procedures post-SG placement was significantly improved compared to that before SG placement (P < 0.001). Cox proportional hazards regression showed that a target lesion length ≥ 30 mm and procedural defects were independently associated with a lower TLPP after SG treatment for CVOD in HD patients. Conclusion SG placement is safe and effective for the treatment of CVOD in HD patients. SG improves the TLPP of endovascular therapy (EVT) for CVOD. A target lesion length ≥ 30 mm and procedure defects were predictive factors for TLPP.

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“…Managing CVOD poses significant challenges with occasionally necessitating access abandonment. EVT emerged as the preferred approach for CVOD management due to the limitations for surgical interventions, notably the thoracic location of lesions, the advanced age and high comorbidity burden frequently observed in HD patients [18][19][20][21] . However, EVT is not with its drawbacks, including issues such as elastic recoil and restenosis following PTA, which can markedly affect the quality of life and increase medical expense [22][23][24] .…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

Liu,

Wang,

Wang

et al. 2024

Sci Rep

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To assess the efficacy of stent grafts (SGs) in managing central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access, and to identify predictive factors influencing the SG treatment outcomes. HD subjects with CVOD who underwent SGs placement at our center between August 2018 and June 2022 were enrolled. Survival curve analysis using the Kaplan–Meier method and log-rank test was performed. Cox proportional hazards regression analysis was employed to identify predictive factors associated with outcomes. A total of 59 SG implantation procedures for CVOD were analyzed, comprising 30 cases of stenosis and 29 cases of occlusion. The access circuit primary patency (ACPP) at 6, 12, and 24 months post-SG placement were 80.9%, 53.8%, and 31.4%, respectively, while, the target lesion primary patency (TLPP) were 91.3%, 67.6%, and 44.5%, respectively. Subgroup analysis revealed higher TLPP in the stenosis group compared to the occlusion group, although the difference was not statistically significant (P = 0.165). The TLPP was significantly improved by SG placement in those who had antecedent balloon dilations (P < 0.001). Cox proportional hazards regression identified target lesion length ≥ 30 mm and procedure defects as independent predictors of lower TLPP after SG treatment for CVOD in HD patients. SG placement demonstrates safety and efficacy in managing CVOD among HD patients, leading to improved TLPP of endovascular therapy (EVT) for CVOD. Notably, long target lesions (≥ 30 mm) and procedure defects emerged as predictive factors influencing TLPP.

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Medial claviculectomy for the treatment of recalcitrant central venous stenosis of hemodialysis patients

Cited by 15 publications

References 23 publications

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

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

Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

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