Management of Refractory Central Vein Stenosis in Hemodialysis Patient

Abstract

BACKGROUND: Patient with hemodialysis (HD) is prone to central venous stenosis (CVS). The presence of CVS contributed to poor dialysis adequacy. Symptomatic CVS is treated with percutaneous transluminal angioplasty (PTA) with or without a stent. This report aimed to understand the characteristics of PTA with or without a stent. CASE PRESENTATION: A 43-year-old woman was admitted to the hospital with a chief complaint of a deteriorating swollen right arm with pain 1 week prior. Patient had been on HD since 2019, had AV shunt access, continuous ambulatory peritoneal dialysis (CAPD), and 4 times balloon angioplasty due to similar complaints. Diagnoses of the patient were AV shunt stenosis, chronic kidney disease Stage 5 on CAPD, heart failure Stage C FC II, hypertension on treatment, anemia related to renal disease, and severe hypoalbuminemia based on anamnesis and extensive examination. PTA with stent was conducted in this patient and showed TIMI Flow III. CONCLUSION: PTA is the primary treatment for symptomatic CVS. A stent implantation is used in cases that failed PTA treatment. PTA with a stent provides immediate symptom alleviation and benefits an angioplasty-resistant lesion by secondary patency.