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Abstract

Introduction:

Recurrent central venous restenosis is problematic in patients with ipsilateral arteriovenous fistula. We report our experience using a drug-eluting stent for the treatment of recurrent central vein restenosis.

Case report:

A 60-year-old man consulted our hospital because of recurrent swelling of his left upper limb with radial-cephalic arteriovenous fistula that originated in the distal forearm. More than 3 years prior, two bare-metal stents were placed for the obstructed lesions in the left subclavian and brachiocephalic venous lesions, and repeated balloon angioplasty for recurrent in-stent stenosis was performed approximately every 3 months. Angiography with iodinated contrast agents revealed an approximately 3-cm-long restenosis at the distal part of the bare-metal stents. One drug-eluting stent (Zilver PTX Drug-Eluting Peripheral Stent; Cook Medical, Bloomington, IN, USA) was deployed at the narrowing lesion, followed by balloon angioplasty. The stenotic lesion was successfully and safely dilated. The patient consulted our hospital 5.5 months after drug-eluting stent placement because of restenosis at the distal part of the drug-eluting stent, but only in a shorter segment than before. Freedom from clinically driven target-lesion revascularization (TLR) extended from 3.1 to 5.5 months after drug-eluting stent placement. Although additional implantation of the second drug-eluting stent was required 14.6 months after the first drug-eluting stent placement, freedom from TLR before/after the second drug-eluting stent placement extended from 4.4 months to more than 8.6 months.

Conclusion:

Drug-eluting stent placement is an effective strategy for recurrent central venous stenosis in patients with ipsilateral arteriovenous fistula. To our knowledge, this is the first report of drug-eluting stent placement for recurrent venous stenosis in a patient undergoing hemodialysis.

Keywords

Drug-eluting stent central venous restenosis in-stent restenosis hemodialysis Zilver PTX target-lesion revascularization

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The efficacy of drug-eluting stent for recurrent central venous restenosis in a patient undergoing hemodialysis