Percutaneous Venoplasty for Central Venous Stenosis: Effect on Patient's Symptoms and Patency of Arteriovenous Accesses.

Abstract

To determine symptomatic relief and patency rate of arteriovenous (AV) fistulae and grafts after venoplasty in patients with central venous stenosis (CVS) on hemodialysis. Case series. The Aga Khan University Hospital, Karachi, from January 2012 to December 2017. The data of patients who had one session of successful venoplasty for CVS were reviewed. The outcomes measured were symptomatic recovery and improvement in the patency of AV accesses. Symptomatic recovery was termed 'complete', when there was complete symptomatic relief after venoplasty; and 'partial' when the procedure was technically successful, but symptoms were not resolved. Primary patency of AV access was the duration from first intervention till further intervention. Cumulative patency was the total duration of time fistula remains patent with multiple interventions. Events, considered end points to functional access status, were placement of new access site, ligation of access site, dialysis catheter placement or the patient death. Thirty-five patients had technically successful venoplasty with mean age of 56.86 ±14.6 years. Twenty-one (60%) were female patients. All patients tolerated the procedure well. Twenty-one (60%) patients had complete relief of symptoms. Fourteen patients (40%) had partial relief of symptoms. Twenty-one patients required repeat angioplasties. The mean follow-up was 18.6 ±9.02 months. Primary patency was 40%, 24%, 24% at 6, 12 and 24 months. Cumulative patency was 69%, 66% and 59% at 6, 12 and 24 months. Percutaneous venoplasty provided symptomatic relief to the patients and improved the short-term patency of AV accesses.