Percutaneous transluminal angioplasty for central venous disease in dialysis patients: influence on cardiac function.

Abstract

Increased vascular access flow after percutaneous transluminal angioplasty (PTA) for central venous stenosis and occlusion (central venous disease, CVD) can affect cardiac function in hemodialysis (HD) patients. We evaluated the cardiac function, etiology, and treatment in HD patients with CVD. HD patients with CVD treated by PTA between June 2006 and February 2013 were studied. Of the 26 patients, 22 had left arteriovenous fistulas (AVFs), 1 left arteriovenous graft (AVG), 2 right AVFs, and 1 right AVG. CVD sites were the left brachiocephalic vein (LBCV; n=13), left subclavian vein (LSCV; n=7), both LBCV and LSCV (n=3), right BCV (n=2), and right SCV (n=1). Computed tomography findings indicated a high extrinsic compression rate for the LBCV (91%) and LSCV (50%). The success rate of PTA was 96%. The primary patency rates at 3, 6, 9, and 12 months were 81%, 73%, 65%, and 57%, respectively. The post-PTA brachial artery flow volume was significantly increased compared with the pre-PTA volume (1306 vs. 957 ml/min; p=0.005). The post-PTA left ventricular ejection fraction and expiration inferior vena cava diameter were the same as the pre-PTA values (57% versus 60%, p=0.2 and 17 versus 17 mm, p=0.9, respectively). Our findings suggest that increased vascular access flow after PTA for CVD has no relation to cardiac function.