The role of angioplasty in haemodialysis patients with symptomatic venous hypertension owing to central venous stenosis

Abstract

Background Central venous stenosis (CVS) is a serious problem in hemodialysis (HD) patients, often presenting with symptoms of venous hypertension. Endovascular treatment is aimed to provide symptomatic relief and to maintain HD access patency. Aim To evaluate our experience in the endovascular treatment of CVS in HD patients and to determine the relationship between the temporary catheter insertion, the type of arteriovenous fistula, and development of CVS. Patients and methods A prospective study was carried out on 30 patients with End Stage Renal Disease (ESRD) undergoing HD presented with symptomatic venous hypertension in the same side of vascular access, between October 2015 and October 2017. All the patients underwent endovascular treatment and were analyzed. Results A total of 30 (20 male and 10 female) patients underwent endovascular interventions for CVS during a time period of 2 years, where 20 stenotic segments were in subclavian vein, six in innominate vein, and four in iliac veins. The technical success rate for endovascular treatment was 80%. Eighteen (75%) patients were treated by ballooning of the stenosed segment alone, whereas six (25%) patients needed primary stenting owing to tight recoiling of the stenotic lesion. Four patients needed reintervention during follow-up (three cases managed by balloon dilatation alone and one needed venous stent after dilatation). Conclusion Endovascular treatment is safe and effective in managing CVS. The incidence of CVS is higher with central venous catheter insertion and proximal arteriovenous fistula.