Success Rate of Endovascular Intervention in the Treatment of Central Venous Stenosis or Occlusion in Hemodialysis Patients

Abstract

Background: Central venous stenosis or occlusion (CVSO) is a major complication in hemodialysis patients that significantly affects morbidity and failure of the peripheral arteriovenous fistula (AVF). However, the best treatment is still unknown (surgical or endovascular). Endovascular treatment is a widely accepted option that includes percutaneous transluminal angioplasty (PTA) with or without stenting. The optimal endovascular treatment is still undetermined. Aim: To study the success rate and effect of endovascular intervention as angioplasty alone or with stenting, in patients with CVSO as optimal endovascular treatment still undetermined. Patients and Methods: this is uncontrolled clinical trial was conducted in Suez Canal University Hospital in the period between July 2017 to July 2019 and follow-up for 12 months. Thirty-four patients with compromised upper limb arteriovenous fistula due to CVSO were included to assess the patency rate of primary angioplasty with or without stenting. Any patients with (mediastinal lesion invading central veins, ipsilateral peripheral vein stenosis, or infected AVF) were excluded. Results: The mean age of studied patients was 53.06±8.49 with a slightly larger number (19) of females (56%). Pre-intervention, the innominate vein was the highest affected with lesion by 41%. Occlusion was in 9 patients (26%), while; 25patients (74%) had stenotic lesion. The success rate of primary patency was 55%, follow-up of the successful cases at 3, 6, and 12 months with patency rate 91%,77%, and 59% respectively. There was no significant difference in the patency rate during one-year follow-up regarding the use of angioplasty alone or with stenting. Conclusion: percutaneous transluminal angioplasty with or without stenting according to our results is successful, safe, and effective in managing central venous lesions in compromised AVF in hemodialysis patients.