Long-term efficacy of subclavian vein stenting in a patient on hemodialysis complicated by stasis dermatitis due to subclavian vein stenosis

Abstract

Data about the long-term safety and efficacy of stent implantation for central venous stenosis in patients on dialysis are limited. We report the case of a 66-year-old man on hemodialysis for end-stage renal disease who presented with stasis dermatitis around an arteriovenous shunt with ulceration of the left forearm. Computed tomography angiography showed a tight stenosis of the proximal left subclavian vein and the development of collateral blood vessels around the stenosis. Percutaneous transluminal angioplasty (PTA) was performed and a bare nitinol stent was implanted in this lesion with intravascular ultrasound (IVUS) guidance. After PTA, the stasis dermatitis improved and the left arm circumference decreased significantly. No stent-related adverse events, such as stent occlusion, left arm swelling, and shunt failure, had occurred by 10 years after PTA. Generally, the patency rate after stenting for central vein stenosis is considered unfavorable. However, in this case, long-term patency might have been achieved by precise assessment of the vessel diameter using IVUS, implantation of a self-expandable stent of the appropriate size, and initiation of post-stenting antithrombotic therapy. This is the first report that highlights the long-term safety and efficacy of IVUS-guided stent implantation in a patient with shunt failure. Learning objectiveWe report a 66-year-old man on hemodialysis with ulcerating stasis dermatitis around an arteriovenous shunt due to subclavian vein stenosis. We implanted an appropriately sized self-expandable stent using intravascular ultrasound. The patient's clinical course has been uneventful in the past 10 years. This case demonstrates the long-term efficacy of intravascular ultrasound-guided stent implantation for central venous stenosis in a patient with shunt failure.