Central venous stenosis in chronic hemodialysis patients: The effect of percutaneous angioplasty and stenting

Abstract

Background: Central venous stenosis in chronic hemodialysis patients occurs in about 17% of all venous stenosis and it is associated with central vein catheterization. We evaluated the effect of percutaneous angioplasty and stenting in the treatment of central venous stenosis in hemodialysis patients. Methods: We retrospectively investigated the medical records of a total of 31 dialysis patients who had central venous stenosis. We reviewed the causes of central venous stenosis, clinical manifestations, venographic findings, and patency rate of radiological intervention. Results: Of the total 31 patients, 28 patients had past history of central vein catheterization ipsilateral to vascular access. Mean duration of the catheterization was 32 ± 14 days. Venography showed complete obstruction of central vein (n = 14) and stenosis (n = 17). The site of venous lesion was right subclavian vein (n = 11), innominate vein (n = 9), left subclavian vein (n = 7), and superior vena cava (n = 14). A total of 30 procedures of angioplasty with or without stenting were performed in 26 of 31 patients. Initial success rate was 96.1% and there was no severe complication such as rupture or bleeding. The primary patency rate at 6, 12, 24, and 48 months after the procedure was 87.3%, 75.6%, 67.9%, and 65.4%, respectively. The cumulative patency rate at the same time point was 96.0%, 90.6%, 74.0%, and 72.8%, respectively. Conclusion: Our data suggest that angioplasty with or without stenting is safe and effective in the treatment of central venous stenosis in hemodialysis patients.