Endovascular Management of Central Thoracic Veno-Occlusive Diseases in Hemodialysis Patients: A Single Institutional Experience in 69 Consecutive Patients

Abstract

To assess the functional status and long-term outcomes of endovascular management for the treatment of central veno-occlusive disease in patients undergoing hemodialysis. Retrospective chart evaluation of 600 patients with threatened upper extremity dialysis access showed central veno-occlusive disease in 69 patients (11%; 30 women and 39 men; mean age, 63.9 years; age range, 26-92 years). A total of 92 venous segments were involved with disease. Initial endovascular procedures consisted of transvenous angioplasty (n = 88) and stent placement (n = 6); there were 134 repeat interventions (14 stents). The mean follow-up was 14.5 months (range, 1-44 months). Angiographic data were reviewed prospectively by two independent observers for the extent of veno-occlusive disease. Technical failures were defined as residual stenosis of at least 30% or lesions that were unable to be dilated or crossed. Statistical analysis, including interobserver agreement and Kaplan-Meier analysis, was performed. Technical success rates for initial and follow-up interventional procedures were 90% (81 of 92 segments) and 96% (129 of 134 interventions), respectively. Two complications required treatment with interventional procedures. There was excellent interobserver agreement (kappa = 0.84; 95% confidence interval: 0.67, 0.93) for grading the degree of venous stenoses. Primary patency rates of hemodialysis access at 1, 6, and 12 months were 81%, 46%, and 22%, respectively, which significantly (P = .001) improved to assisted patency rates of 91%, 77%, and 63% at 1, 6, and 12 months, respectively. Endovascular management including a combination of angioplasty and selective stent placement can be effectively used to treat central veno-occlusive disease and preserve functional access in patients with threatened upper extremity dialysis access.