Balloon Venoplasty Research Articles

Percutaneous balloon venoplasty for symptomatic lead-related venous stenosis

BackgroundLead-related venous stenosis (LRVS) is common after transvenous lead implantation and generally diagnosed incidentally. Symptomatic LRVS, causing discomfort and swelling, is less common. ObjectiveWe report on the management and outcomes of patients with symptomatic LRVS after percutaneous balloon venoplasty. MethodsWe included patients with symptomatic LRVS unresponsive to >30 days of anticoagulation who underwent venoplasty at the Hospital of the University of Pennsylvania between 2014 and 2020. Transvenous lead extraction (TLE) was performed first if the lesion could not be crossed with a wire. ResultsEighteen patients (mean age, 62 ± 10 years; 44% female) underwent 27 venoplasty procedures. Symptoms included arm swelling in 9 (50%), facial/neck swelling in 1 (6%), and both in 8 (44%). Venography revealed LRVS in the axillary/subclavian veins in 10 (56%), the brachiocephalic vein in 6 (33%), and the superior vena cava in 4 (11%). Most patients (83%) required TLE before venoplasty, and only 5 of 18 (28%) remained with leads crossing the stenosed segment. Thirteen patients (72%) had complete symptom resolution, 4 (22%) had partial resolution due to secondary lymphedema, and 1 showed no improvement. Patients with complete resolution had shorter times from symptom onset to intervention (195 vs 690 days; P = .02). ConclusionLRVS can affect any part of the venous system and may be manifested with swelling of the arm, face/neck, or both. Balloon venoplasty is safe and effective, often requires TLE, and is particularly durable when leads no longer cross the stenosed region. Venoplasty is less effective for secondary lymphedema, highlighting the need for timely intervention.

Tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention.

Bleeding from the puncture tract after percutaneous transhepatic portal vein intervention can become life-threatening. To date, studies about tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention are only with small numbers of patients, or non-consecutive or pediatric patients with a relatively small sheath in diameter. To evaluate the safety and efficacy of tract embolization with gelatin sponge strips after percutaneous transhepatic poral vein access. Between September 2017 and February 2024, 100 consecutive patients (61 men, 39 women; mean age = 53 ± 15 years) underwent a total of 105 portal vein interventions using a percutaneous transhepatic approach. Tract embolization for the removal of 6-8 Fr sheath was performed using gelatin sponge strips in all procedures, including 71 portal vein embolization before major hepatectomy, 27 portal balloon venoplasty or stent placement after liver transplantation, and seven other interventions. No bleeding occurred after tract embolization with gelatin sponge strips. Minor portal vein thrombosis was detected in three procedures after liver transplantation and in one procedure for portal vein stenosis caused by essential thrombocytopenia. Thrombosis occurred in the punctured portal vein branch in all procedures. Thrombosis was not clinically relevant in any patient, and it was difficult to differentiate whether thrombosis was caused by sheath placement or the inserted gelatin sponge. Tract embolization with gelatin sponge strips after percutaneous transhepatic portal vein intervention is a safe and feasible method for preventing hemorrhage from the puncture tract.

Balloon venoplasty for right heart catheterization from the arm in patients with subclavian vein stenosis.

In the trans-radial era, arm venous access for right heart catheterization (RHC) is rising. Procedural success is affected by many factors, including subclavian/innominate vein stenosis (SVS) and pre-existing wires or catheters. In a study published previously by the same authors, 2% of cases had unsuccessful RHC through the arm, predominantly due to SVS. Since that study, techniques to improve RHC success rates have been developed, including crossing the stenosis with a coronary guidewire, followed by balloon dilatation. We aimed to determine whether subclavian/innominate venoplasty allows successful RHC in patients with SVS. Our retrospective study included patients who had RHC from the arm between November 1, 2019, and December 31, 2022 that was unsuccessful due to the inability to pass a catheter through the SVS, and then underwent balloon venoplasty. The success rate of completed RHC was then assessed. Out of 2506 RHCs via arm access, 2488 were successful with a catheter alone or over a guidewire. In 18 patients, venoplasty was needed for catheter passage over a guidewire. Post-dilatation, all 18 cases (100%) had successful RHC with a mean procedural time of 35.2 (SD = 15.5) minutes. The most common stenosis site was the subclavian vein in 13 patients (72.2%), and 12 patients (66.7%) had pacemaker/ implantable cardioverter defibrillator wires present. Balloon dilatation of SVS is an efficacious method to improve the success rate of RHC from the arm. It is a safe technique that may prevent cross-over to a different access site, thereby improving patient satisfaction and reducing the possibility of alternate site complications.

Laser Atherectomy as a Novel Revascularization tool in Chronic Venous Occlusion

We describe a 66-year-old male who was complaining of worsening left leg sweeling and pain due to chronic bilateral common femoral venous occlusion due to prior abdominal surgery fifteen years ago. He was treated by endovascular intervention where novel endovascular recanalization of the ilio-femoral veins using balloon venoplasty with adjunctive use of Laser atherectomy safely and effectively was demonstrated.

Atypical May-Thurner Syndrome Caused by Large Lumbar Osteophyte

AbstractAn 82-year-old man presented to the emergency department with intermittent left lower extremity swelling for the last 4 to 5 months that limited his daily activities. The patient had a negative lower extremity venous duplex 3 months prior and had been treating symptoms with compression stockings but experienced no improvement. Venography showed venous outflow obstruction in his left common iliac vein and the etiology was confirmed to be a lumbar vertebral osteophyte compressing the vein. The patient underwent endovascular treatment with balloon venoplasty and stent placement over the lesion with return of adequate outflow. This report describes treatment of symptomatic left common iliac venous compression with endovascular therapy alone.

Multimodal Approach for the Treatment of Extensive Bilateral Iliofemoral Deep Vein Thrombosis

Abstract Iliofemoral vein thrombosis is the primary cause of deep vein thrombosis (DVTs) in the lower extremities in around 25% of the cases. Restoration of venous outflow is the primary goal in the management of DVT which can be achieved by combined endovascular techniques such as balloon venoplasty and/or stenting, thrombectomy, and pharmacomechanical thrombolysis. At presently, percutaneous mechanical thrombectomy (PMT) devices, such as rheolytic thrombectomy device, are replacing conventional approaches for clot removal. Although the use of rheolytic thrombectomy device for DVT is associated with the risk of intravascular hemolysis, we report a safe and successful use of multimodal approach using rheolytic thrombolytic device for the management of a case of bilateral iliofemoral DVT. In our study, we noticed early relief in pain and reduced lower limb edema in a week with a reduced dose of thrombolytic agent and hospital stay in a 44-year-old male who was admitted with bilateral extensive iliofemoral DVT using a multimodal approach.

TCT-737 Balloon Venoplasty for Right Heart Catheterization From the Arm in Patients With Subclavian Vein Stenosis

TCT-737 Balloon Venoplasty for Right Heart Catheterization From the Arm in Patients With Subclavian Vein Stenosis

Clinical characteristics of hemodialysis patients with left brachiocephalic vein obstruction due to extrinsic compression or prior catheterization.

Left brachiocephalic vein (LBCV) stenosis is a common complication in hemodialysis patients and is a heterogenous disorder associated with either prior catheterization or extrinsic compression. This study aimed to characterize patients with LBCV stenosis or occlusion with and without a history of central venous catheterization. We performed a retrospective study in 84 hemodialysis patients with LBCV stenosis or occlusion with (n = 22) or without (n = 62) prior catheterization. We compared the clinical features, anatomical factors, restenosis after balloon venoplasty, and patency rates of patients in these two groups. In the cohort of 84 patients with LBCV stenosis or occlusion, 73.8% (62 patients) of them had no history of catheterization. Patients without prior catheterization had more stenotic lesions (p < 0.05) but less occlusive lesions (p < 0.05) than patients with prior catheterization. The space between the sternum and the aorta was narrower in patients without prior catheterization than that in patients with prior catheterization (p < 0.05). Percutaneous venography was performed in 81 patients, and the occurrence of recoil after venoplasty in patients without prior catheterization was significantly higher than that in patients with prior catheterization (p < 0.05). The rate of stent implantation was significantly higher in patients without prior catheterization than patients with prior catheterization (p < 0.05), whereas there was no significant difference in primary patency between the two groups. LBCV stenosis and occlusion are mainly due to extrinsic compression rather than prior central venous catheterization. Stent implantation is frequently required after venoplasty to treat LBCV obstructive lesions in patients without prior catheterization.

Single-center experience with catheter-directed thrombolysis and balloon angioplasty for acute upper-extremity deep vein thrombosis: a case series study

BackgroundEffective treatment of upper extremity deep vein thrombosis (UEDVT) is crucial to prevent further complications. Various treatments, including percutaneous mechanical thrombectomy (PMT), catheter-directed thrombolysis (CDT), decompression surgery, and venoplasty are suggested for UEDVT. However, no prospective study has yet favored any of these treatments. This study presents a review of our experience with CDT followed by balloon venoplasty in patients with acute primary UEDVT.MethodsWe enrolled all patients diagnosed with acute UEDVT from January 2020 to June 2021. Subjects with UEDVT due to secondary causes like malignancies, indwelling catheters, or leads were excluded. CDT was performed through brachial vein access, using a perfusion catheter, and rt-PA administration. Balloon venoplasty was performed if the treated segment had remaining stenosis after CDT. Patients were followed up at the vein clinic for any signs and symptoms in the upper extremity and lifestyle changes. Follow-up ultrasonography was done 12 months after discharge.ResultsTwelve patients with a mean age of 41.08 ± 14.0 years were included in the study. The mean duration of CDT was 25.00 ± 10.56 h. After CDT, all patients had remaining occlusions, with seven having more than 50% remaining stenosis. However, after balloon venoplasty, no patient had significant (more than 50%) stenosis. There was no serious complication after both procedures. Patients were followed up for a mean duration of twelve months after their admission, with a mean time of maintenance anticoagulation was 10.73 ± 5.77 months. Only one patient had recurrent symptoms in his target limb which required a decompression surgery, while the rest were free of symptoms in their treated extremity. No subject developed pulmonary emboli (PE) during admission or the follow-up period. There was no evidence of hospital readmission for any reason. Upper extremity color-doppler sonography of the patients at twelve months after their procedure showed normal venous flow without any significant stenosis in 8 (66.7%), and partially normal flow with patent target vein in 4 (33.3%) patients.ConclusionsCDT followed by balloon venoplasty may be an effective treatment for selected patients with acute primary UEDVT, providing desirable long-term results and potentially avoiding the need for decompression surgery in the short or long term.

Abstract 555: Technique For Testing Drug-coated Balloons In Deep Veins In Vivo

Background: Chronic deep venous occlusions, leading to outflow obstruction in dialysis patients and post thrombotic syndrome (PTS) in DVT patients, are often treated with balloon venoplasty and stenting to restore flow and improve limb outcomes. In stent restenosis and occlusion are primary reasons for late intervention failure. mTOR inhibitors might impact thrombotic and fibrotic pathways on venous endothelial cells (VEC). Methods: Immortalized murine VEC (EOMA, ATTC #CRL-2586) were stimulated with sirolimus (1ng) and vehicle (DMSO) performing quantitative real-time PCR (qRT-PCR). Sprague Dawley rats (n=4, 250-400g) were anesthetized (isoflurane). IVC diameter measured by ultrasound. Infrarenal IVC was exposed using a midline laparotomy, side branches ligated, posterior venous branches cauterized, and micro-clips temporarily placed. A 0.014 sharpened guidewire with a DCB back-loaded was inserted retrograde into the infrarenal IVC. After DCB inflation/deflation, the entire system was removed and U-stitch tightened for hemostasis. Results: Sirolimus blunted transcription of cellular adhesion molecules (CAMs) and mediators of EndMT. (Fig 1) We achieved total stasis to replicate a vein wall reaction to thrombosis and further EndMT changes, with 75% survival in initial proof-of-concept experiments. (Fig 2) Conclusion: IVC retrograde cannulation via U-stitch and sharpened guidewire is a viable animal model for testing venous DCBs. Sirolimus inhibits VEC CAMs critical for thrombus initiation and EndMT mediators involved in PTS remodeling. Future DCB research on adhesive and fibrotic phenotypes is required.

Abstract 9696: Long-Term Outcomes With Abandoning versus Extracting Sterile Leads: A 10-Year Population-Based Study

Background: Long-term outcomes of lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) during cardiac implantable electronic devices (CIED) procedures requiring lead addition or replacement remain unclear. Hypothesis: We hypothesized that there is no difference in long-term (10-year) outcomes of LA versus TLE during CIED procedures requiring lead addition. Methods: We performed a retrospective cohort study of a population residing in seven adjacent counties of southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE for sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10-years or until their death were included. Outcomes were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system. Results: A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. In long-term follow-up, indications for subsequent lead extraction arose in 9.1% (n=14) of patients with initial LA and 5.3% (n=1) in patients with initial TLE, after an average of 7-years. Moreover, out of 14 patients, who required secondary extraction in the LA cohort, 28.6% did not proceed with the extraction. Of the remaining 10 patients, 60% had clinical success and 40% had a clinical failure with the extraction. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges such as requiring balloon venoplasty or serial dilation (5.2% vs. 5.3%, P=1.0). There was no difference in 10-year survival probability among LA group and TLE group (P=0.64). Conclusion: Indications for subsequent extraction arose in 9.1% of patients with the initial LA approach for sterile leads after an average of 7.3 years and 28.6% did not proceed with the extraction. Of the patients who underwent the subsequent extraction, 60% had clinical success and 40% had a clinical failure. There was no difference in 10-year survival probability between patients with the initial LA approach or TLE approach.

Excellent results seen with both transaxillary and infraclavicular approaches to first rib resection in patients with subclavian vein thrombosis

BackgroundVenous thoracic outlet syndrome (VTOS) is a debilitating condition with several well-documented treatment paradigms. We reviewed the outcomes from a large academic institution of patients who had undergone transaxillary first rib resection with delayed venography (TA) or infraclavicular first rib and subclavius muscle resection with concomitant venography (ICV) for VTOS with subclavian vein thrombosis. MethodsWe performed a retrospective review of the medical records of all patients who had undergone first rib resection and scalenectomy for VTOS with subclavian vein thrombosis at a single academic institution. The demographics, presentation, operative records, and outcomes were collected. Descriptive statistics were used to compare the two groups. ResultsA total of 73 patients had undergone first rib resection for VTOS during the study period. Of the 73 patients, 36 (49%) had presented with thrombosis of the subclavian vein and were included in the present review. Of the 36 patients, 26 (72%) had undergone TA and 10 (28%) had undergone ICV. No significant differences were seen between the two groups in female gender (54% vs 50%; P = 1.00) or age (28.7 years vs 29.5 years; P = .88). A higher percentage of the ICV group had undergone preoperative thrombolysis (70% vs 27%; P = .02). All the patients in the ICV group had undergone intraoperative balloon venoplasty at resection. The mean time from thrombosis to resection was 2.3 months. All of the TA group had undergone venography at 2 weeks postoperatively. Venography had revealed 15 stenotic veins requiring venoplasty, 8 widely patent veins, 1 acutely thrombosed vein, and 3 chronically occluded veins. The time from initial thrombosis to surgical intervention was 10 months for the patent group, 6 months for the stenotic group, and 4 months for the occluded group. In the TA group, 19% of the patients had required chest tube placement intraoperatively for pneumothorax. In the ICV group, complications included postoperative hematoma (n = 1), wound infection (n = 1), and hemothorax (n = 1). The mean length of stay was 1.04 days for the TA group and 2.00 days for the ICV group (P < .0001). The mean follow-up was 10.4 months and 15.8 months for the TA and ICV groups, respectively. No mortalities were reported. No differences in the vein patency rates were seen between the two groups at follow-up (TA, 93%; vs ICV, 100%; P = 1.00). All the patients were asymptomatic at follow-up. ConclusionsThe outcomes for the patients who had undergone TA or ICV for subclavian vein thrombosis were excellent with no mortality and few complications. The subclavian vein patency rates were high, and all the patients were asymptomatic at follow-up.

Cortical morphology predicts placebo response in multiple sclerosis

Despite significant insights into the neural mechanisms of acute placebo responses, less is known about longer-term placebo responses, such as those seen in clinical trials, or their interactions with brain disease. We examined brain correlates of placebo responses in a randomized trial of a then controversial and now disproved endovascular treatment for multiple sclerosis. Patients received either balloon or sham extracranial venoplasty and were followed for 48 weeks. Venoplasty had no therapeutic effect, but a subset of both venoplasty- and sham-treated patients reported a transient improvement in health-related quality of life, suggesting a placebo response. Placebo responders did not differ from non-responders in total MRI T2 lesion load, count or location, nor were there differences in normalized brain volume, regional grey or white matter volume or cortical thickness (CT). However, responders had higher lesion activity. Graph theoretical analysis of CT covariance showed that non-responders had a more small-world-like CT architecture. In non-responders, lesion load was inversely associated with CT in somatosensory, motor and association areas, precuneus, and insula, primarily in the right hemisphere. In responders, lesion load was unrelated to CT. The neuropathological process in MS may produce in some a cortical configuration less capable of generating sustained placebo responses.

Post-Liver Transplant Inferior Vena Cava Stenosis in a Large Volume UK Centre

Background: Inferior vena cava stenosis (IVCS) is a rare complication following liver transplantation. Limited consensus exists on management of IVCS. We report the management and outcomes of patients with IVCS at our centre. Methods: Data were collected from adult patients undergoing liver transplantation at our centre between October 2014 and August 2020. Data included demographics, investigation and management regarding IVCS. Values presented as % of total and median with interquartile range (IQR). Results: 636 liver transplants were performed during the study period, with 48 (7.6%) investigated for possible IVCS, and 14 of those (2.2% of total) were found to have IVCS. 85.7% (n=12) were female and 2/14 were re-transplants. 10 livers (71.4%) were from DBD donors. Normothermic machine perfusion was used in 4/14 patients. All 14 recipients found to have IVCS had implantation using a modified piggyback cavocavostomy technique. IVCS was identified at a median of 25.5 days (19.7-30.8 days) following transplantation within the suprahepatic IVC in 92.9% (n=13). 8/14 recipients underwent intervention for IVCS; 6 patients underwent balloon venoplasty, 1 required IVC stenting and 1 was managed surgically. Six recipients with IVCS died, 4 of whom had an intervention for their stenosis. 3 of these were within 90 days of transplant. Pressures measured at the anastomotic stricture were higher in those who succumbed (median of 21 Vs 12.5 mmHg; p=.017). Conclusions: At our centre, cava-replacement technique was not associated with IVCS. Patients with significant strictures (evidenced by higher pressures at anastomotic stenosis) may have increased mortality risk.

P-L17 Post-liver transplant inferior vena cava stenosis in a large volume UK centre

Abstract Background Inferior vena cava stenosis (IVCS) is a rare complication of liver transplantation with a reported incidence rate of 3%. Limited clinical consensus exists on the management of IVCS. We report the management and outcomes of patients with IVCS at our transplant centre. Methods Relevant data were collected from adult patients who underwent liver transplantation at our centre between October 2014 and August 2020. These included demographics, investigation and management details with regards to IVCS. Values presented as % of total and median with interquartile range (IQR). Results A total of 636 liver transplants were performed during the study period, of which 48 (7.6%) patients were investigated for possible IVCS. Of those, 14 (2.2% of total) were found to have IVCS, 85.7% (n = 12) were female. Only 2/14 were re-transplants and pre-transplant portal vein thrombus was present in 3 cases (21.4%). 10 livers (71.4%) were DBD donors. Normothermic machine perfusion was used in 4/14 patients. All 14 recipients found to have IVCS had had an implantation using a modified piggyback cavocavostomy technique. The IVCS was identified at a median of 25.5 days (19.7-30.8 days) following transplantation within the suprahepatic IVC in 92.9% (n = 13). Hemi-azygos collateralisation was seen in 4 cases (28.6%). 8 of the 14 recipients underwent intervention for IVCS, 6 patients were managed with balloon venoplasty, 1 patient required an IVC stent and 1 was managed surgically. Six of the recipients with IVCS died, 4 of whom had an intervention for their stenosis and 3 of these were within 90 days of their transplant. Pressures measured at the anastomotic stricture were higher in those who succumbed (median of 21 Vs 12.5 mmHg; p=.017). Conclusions At our centre, cava-replacement technique was not associated with IVCS. Patients with more significant strictures (as evidenced by higher pressures at the anastomotic stenosis) may have an increased mortality risk.

Treatment of an Unyielding Central Vein Stenosis using Valvuloplasty Balloon in a Young Female Presenting with Ineffective Hemodialysis

Abstract Percutaneous balloon venoplasty is widely employed for the management of central vein stenosis (CVS), a condition frequently encountered in patients on maintenance hemodialysis (MHD). The hypertrophied and fibrotic venous stenotic lesions often pose a challenge for interventionists, due to resistance to dilatation and high-elastic recoil. We report here successful utilization of mitral valvuloplasty balloon for percutaneous treatment of an unyielding brachiocephalic vein stenosis. Repeated failure of conventionally used peripheral balloon dilatation catheter prompted the use of a mitral valvuloplasty balloon that could exert higher radial pressure while preventing melon-seeding and hence successfully achieve stenosis dilatation. The mitral valvuloplasty balloon can be effectively and safely used for lesions resistant to repeated dilatations by conventional peripheral balloons. Rheological stress on central veins from ipsilateral arteriovenous fistula (AVF) may result in development of stenotic lesions, even in the absence of prior venous catheterization of the affected vein; therefore, in the presence of relevant symptoms, this diagnosis should not be excluded on the basis of absence of prior direct trauma at the stenosis site.

Venoplasty to gain venous access during cardiac device implantation is feasible and safe

Abstract Funding Acknowledgements Type of funding sources: None. Background Venous obstruction is relatively common after cardiac implantable electronic device (CIED) implantation. After CIED implantation 15% of the patients present with a severe or total occlusion. This poses a problem during lead revisions or upgrades often leading to implantation failure or complex extraction or lead tunneling procedures. Percutaneous balloon venoplasty might be a suitable option but is rarely performed. Purpose To identify the feasibility and safety of venoplasty during cardiac device implantation procedures. Methods We retrospectively included consecutive cardiac device implantations in which venoplasty was performed during the same procedure from December 2018 until December 2020. The venoplasty was done either planned or ad hoc, by an interventional radiologist. Results We included 17 patients, 14 (82%) were male, aged 73 ± 11 years. Fifteen (88%) patients required an upgrade or lead revision and two were de novo implantations. The subclavian vein was the site of occlusion in 13 (76%) patients. In 16 (94%) patients venoplasty was successful and all intended leads could be implanted subsequently. In the patient with the unsuccessful recanalization both an antegrade and retrograde approach via the vena femoralis was attempted. No venoplasty related complications occurred. The figure shows a succesful upgrade from a single chamber ICD (panel A) to a CRT-D (panel D) after venoplasty for a total occulsion of the vena subclavia (panel B and C). Conclusions Percutaneous balloon venoplasty is a safe and feasible method for patients in whom venous access is an issue during CIED implantation. This method can be performed ad hoc and prevents contralateral lead implantation with tunneling or lead extraction. Abstract Figure. Venoplasty during upgrade.

The secondary patency after patch venoplasty versus balloon venoplasty in management of neointimal hyperplasia of the venous anastomosis of thrombosed arteriovenous grafts for hemodialysis

Background The pathogenesis of neointimal hyperplasia associated with hemodialysis arteriovenous (AV) grafts is complex and likely involves surgical manipulation of the tissues, material biocompatibility, and mechanical factors. Both surgical and radiological interventions for stenosed and thrombosed AV graft have been described aiming at the optimal restoration of morphology and function. Aim To compare the secondary patency after patch venoplasty and balloon venoplasty in management of neointimal hyperplasia of the venous anastomosis of AV graft for dialysis. Patients and methods This is a double-armed randomized prospective study that was carried out at Ain Shams University hospitals for 2 years. A total of 20 patients with thrombosed synthetic AV graft were enrolled in this study. The first group (10 patients) was treated with patch venoplasty, and the second group (10 patients) with balloon venoplasty adjunctive after surgical thrombectomy. Results Graft patency at 6-month and 12-month follow-up was 90 and 70% for the balloon angioplasty group versus 60 and 40% for the surgical patch venoplasty group (P=0.3 and 0.37, respectively). Conclusion In the present study, the outcome of balloon venoplasty was better than and patch venoplasty for thrombosed AV grafts. In addition to better graft patency, balloon venoplasty offers the advantage of shorter operative time and lower morbidity. Further studies with a large sample size and multicentric cooperation are required to confirm the present findings.

A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access

ObjectiveThis review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access. MethodsAn extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts. ResultsThere were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients. ConclusionsAlthough both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required.

The Intra and Extra Cranial Veins in Relationship with Chronic Migraine: Electroencephalogram Modifications Induced by Balloon Venoplasty

The Intra and Extra Cranial Veins in Relationship with Chronic Migraine: Electroencephalogram Modifications Induced by Balloon Venoplasty