Endovascular Management of Central Venous Stenoses in the Hemodialysis Patient: Results of Percutaneous Therapy

Abstract

The purpose of this study was to determine the functional results of transvenous angioplasty for the treatment of central venous stenoses in patients with failing upper extremity arteriovenous access. Two hundred consecutive patients presented with threatened arteriovenous access from January 1999 through July 2002. Angiographic evidence of central venous stenosis was present in 35 patients (18%) (superior vena cava 5, brachiocephalic veins 14, and subclavian veins 18). Follow-up averaged 873 days from the date of initial intervention. The initial technical success rate was 89%. Primary patency for each intervention was 85% at 30 days, 55% at 6 months, 43% at 1 year, and 0% at 2 years. Assisted primary patency rates were 88% at 30 days, 80% at 1 year, and 64% at 2 years. Freedom from central venous dialysis catheter placement was 82% at 30 days, 63% at 3 months, 51% at 1 year, 37% at 2 years, and 25% at 3 years. Freedom from a dialysis catheter was superior in those patients with autogenous arteriovenous fistulas. Transvenous angioplasty appears to be beneficial for hemodialysis patients with central venous stenoses, and it helps preserve functional access in the affected extremity, particularly in patients with autogenous fistulas.

Get full access to this article

View all access options for this article.

References

Lumsden AB , MacDonald MJ , Isiklar H , et al: Central venous stenosis in the hemodialysis patient: Incidence and efficacy of endovascular treatment. Cardiovasc Surg 5:504-509, 1997.

Glanz S , Gordon DH , Lipkowitz GS , et al: Axillary and subclavian vein stenosis: Percutaneous angioplasty. Radiology 168:371-373, 1988.

Morosetti M , Meloni C , Gandini R , et al: Late symptomatic venous stenosis in three hemodialysis patients without previous central venous catheters. Artif Organs 24:929-931, 2000.

NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation — dialysis outcomes quality initiative. Am J Kidney Dis 30(suppl 3):S150-S191, 1997.

Bhatia DS , Money SR , Ochsner JL , et al: Comparison of surgical bypass and percutaneous balloon dilatation with primary stent placement in the treatment of central venous obstruction in the dialysis patient: One-year follow-up. Ann Vasc Surg 10:452-455, 1996.

Sidawy AN , Gray R , Besarab A , et al: Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 35:603-610, 2002.

Gray RJ , Sacks D , Martin LG , et al: Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee. J Vasc Interv Radiol 10:1405-1415, 1999.

Barrett N , Spencer S , McIvor J , et al: Subclavian stenosis: A major complication of subclavian dialysis catheters. Nephrol Dial Transplant 3:423-425, 1988.

Schwab SJ , Quarles LD , Middleton JP , et al: Hemodialysisassociated subclavian vein stenosis. Kidney Int 33:1156-1159, 1988.

10.

Landwehr P , Lackner K , Gotz R : Dilatation and balloon-expandable stents for the treatment of central venous stenosis in dialysis patients. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 153:239-245, 1990.

11.

Antonucci F , Salomonowitz E , Stuckmann G , et al: Hemodialysis related venous stenoses: Treatment with self-expanding endovascular prostheses. Eur J Radiol 14:195-200, 1992.

12.

Oderich GS , Treiman GS , Schneider P , et al: Stent placement for treatment of central and peripheral venous obstruction: A long-term multi-institutional experience. J Vasc Surg 32:760-769, 2000.

13.

Haage P , Vorwerk D , Piroth W , et al: Treatment of hemodialysis-related central venous stenosis or occlusion: Results of primary Wallstent placement and follow-up in 50 patients. Radiology 212:175-180, 1999.

14.

Verstandig AG , Bloom AI , Sasson T , et al: Shortening and migration of Wallstents after stenting of central venous stenoses in hemodialysis patients. Cardiovasc Intervent Radiol 25:58-64, 2003.

15.

Pruitt A , Dodson TF , Najibi S , et al: Distal septic emboli and fatal brachiocephalic artery mycotic pseudoaneurysm as a complication of stenting. J Vasc Surg 36:625-628, 2002.

16.

Schillinger F, Schillinger D, Montagnac R, et al: Central venous stenosis in hemodialysis: Comparative angiographic study of subclavian and internal jugular access. Nephrologie 15:129-131, 1994.