Percutaneous Treatment of Central Venous Stenosis in Hemodialysis Patients: Long-Term Outcomes

Abstract

The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and 15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months. Each patient was followed for 14 to 60 months. Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%, respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion, endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference in patency between PTAs and stent placement.

Endovascular Stenting for Left Subclavian Venous Stenosis for a Hemodialysis Patient with a Persistent Left Superior Vena Cava

“…8,9) On the contrary, other groups reported that the primary patencies between angioplasty and stent were not significantly different. 10,11) Further, Ozyer et al 12) reported that stent placement for central venous stenosis or occlusion led to a significantly lower primary patency rate than PTA but added to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in such angioplasty-resistant lesions. The most commonly used stents for central venous stenosis or occlusion are self-expandable stents.…”

“…Palmaz stent placement was successfully performed for the stenosis employing the pull-through technique, in which a guidewire was passed from the left internal jugular vein to the access vein. There has been one report of a stent being placed for central venous occlusion or stenosis with the use of the pull-through technique between the femoral vein and access vein 11) . To our knowledge, however, there has been no report of stent placement employing the pull-through technique from the left internal jugular vein to the access vein for subclavian venous stenosis in an HD patient with a PLSVC.…”

Acesso vascular para hemodialise: o que ha de novo?

“…Placement of stents in this position remains controversial. Kim et al 13 have reported that angioplasty restenosis rates are similar with and without stents. Kwok 14 recommends that stents should be reserved for cases of recoil or restenosis within 3 months of angioplasty.…”

Guidelines for basic techniques in vascular access intervention therapy (VAIVT)

“…the entire length of the artery from the origin from the aorta to the arteriovenous anastomosis, the arteriovenous anastomosis (in the case of AVG, the entire graft), and the central vein (draining vein)up to the confluence with the vena cava. 13,18,20,21,30,38,49,78,93 The types of lesions considered to be targets are stenosis, lesions requiring treatment, including both thrombotic and non-thrombotic occlusions. However, in cases involving a central artery or vein, which are likely to require emergency hemostasis if the blood vessel is damaged, each medical facility must determine whether VAIVT is indicated based on the facility s abilities, including whether they have covered stents for hemostasis or surgical backup available.…”

“…Although there is some debate over indications, currently indications on which there is a relative amount of consensus are as follow 3,4,12,13,14,15,30,34,64,66,67,83,84 1. Cases of elastic recoil in which at least 30% of the stenosis remains regardless of the fact that full expansion of a balloon of appropriate diameter was possible.…”