Total central vein obstruction: Resolution with angioplasty and fibrinolysis

Abstract

Percutaneous transluminal angioplasty (PTA) has assumed an important role in the chronic management of malfunctioning and failed fistulas [1–8]. Stenotic lesions, most commonly occurring in the venous limbs of such fistulas, are the most common anatomic cause of malfunction [4]. If left untreated, these stenoses may progress to total occlusion. Central vein stenosis has emerged as a serious new medical complication of hemodialysis catheter insertion [5, 6]. Previous publications suggest that the duration of a peripheral fistula is an important associated factor in addition to a previous central vein cannulation [5, 6]. These central vein lesions are not amenable to simple surgical revision or thrombectomy because of their intra-thoracic location [5, 6]. Previous reports have documented the excellent response of subtotal central vein lesions to PTA [2–6]. This study describes a four year experience with patients presenting with total obstruction of their central venous system. To our knowledge, there have been no other reported series detailing the technique for and results of angioplasty of totally obstructed central veins in hemodialysis patients.