Endovascular treatment of central venous stenoses in patients with dialysis shunts.

Eva Buriánková,Martin Köcher,Zdenek Kojecký,Petr Utíkal,Miroslav Heřman,Marie Černá,Petr Bachleda

doi:10.5507/bp.2003.030

Abstract

Evaluation of long-term results of percutaneous treatment of central vein stenoses or occlusions in patients with haemodialysis shunt. In 26 patients with haemodialysis shunts and confirmed central vein stenosis or occlusion, 28 primary percutaneous transluminal angioplasties (PTA) and 5 repeated PTAs (re-PTA) were performed; in three patients a stent was implanted - primary in one patient and due to early restenosis after PTA in two patients. To maintain stent patency, 10 re-PTA were performed. The technical success rate of primary interventions was 96 % (100 % in stenoses and 50 % in occlusions). Primary post-PTA patency rate was 70 % at 3 months, 60 % at 6 months and 30 % at 12 months. PTA with possible stent implantation is a first-choice method in the treatment of stenoses and occlusions of the central venous system. Despite the relatively frequent re-interventions, endovascular treatment is capable to preserve long-term function of the dialysis shunt.

Highlights

Stenoses or occlusions of the central venous system (CVS) are caused by a wide spectrum of diseases of both malign and benign nature
We performed a total of 28 primary percutaneous transluminal angioplasty (PTA)
Repeated PTA was carried out 5 times and a stent was implanted during this procedure in two patients

Summary

Introduction

Stenoses or occlusions of the central venous system (CVS) are caused by a wide spectrum of diseases of both malign and benign nature. Stenosis or occlusion of the CVS lead to the central venous hypertension which can be the cause of shunt malfuction or even closure[1,2]. Such complications occur in 11–50 % of haemodialytic patients[1,2,3,4]. The most frequently quoted causes of stenosis or occlusion of the central venous system in such patients include acute and chronic trauma caused by the repeated punctures and cannulations of the subclavian veins[2,5,6]. In the case of access via the subclavian vein, stenoses and occlusions are demonstrated in a significantly larger number of cases (up to 42 %), whereas with access via the jugular vein it remains within the range from 0–10 % (ref.[5, 7])

Methods

Results

Discussion

Conclusion