Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary Wallstent placement and follow-up in 50 patients.

Abstract

To analyze the effectiveness of stent placement as the primary treatment for central venous obstruction in patients undergoing hemodialysis. Fifty-seven Wallstents were placed in 50 patients with symptomatic shunt dysfunction and arm swelling due to central venous obstruction. Technical success, complication, and patency rates were evaluated. Stent deployment was successful in all patients, and early rethrombosis (within 1 week) was noted in one patient (2%). Seventy-three episodes of reobstruction occurred and were treated percutaneously with angioplasty alone in 54 cases (74%). Nineteen cases (26%) necessitated additional stent placement. The 3-, 6-, 12-, and 24-month primary patency rates were 92%, 84%, 56%, and 28%, respectively. Cumulative overall stent patency was 97% after 6 and 12 months, 89% after 24 months, and 81% after 36 and 48 months. In the treatment of brachiocephalic and subclavian venous obstruction, stent placement shows excellent technical results and helps preserve vascular access for a substantial period. Multiple repeat interventions are, however, frequently required to maintain patency.