Central Vein Stenosis Research Articles

Risk Factors associated with Central Vein Stenosis Development in Hemodialysis Vascular Access among Patients with Normal Preoperative Venography

We aimed to discover risk factors for central vein stenosis (CVS) in hemodialysis patients with normal preoperative venography. Among the 411 individuals who underwent upper arm venography for hemodialysis access evaluation in 2017, we reviewed venography and medical record data from 349 patients with normal preoperative venography who subsequently underwent arteriovenous fistula creation. We compared the data between patients with and without CVS development. Among the 349 patients, 22 (6.3%) developed CVS during a median 20.9-month follow-up. The development of CVS appeared to be associated with preoperative venography findings (the presence of collateral vessels and cephalic arch stenosis), location of hemodialysis access, and history and duration of ipsilateral hemodialysis catheter placement (p < 0.05). Multivariate analysis identified two or more collateral vessels on venography, left-sided arteriovenous fistula, and a previous history of ipsilateral hemodialysis catheter placement as independent risk factors for CVS development (p < 0.05). Even in patients with normal preoperative venography findings, there is an increased possibility of CVS development after arteriovenous fistula creation if they have more than two collateral vessels on venography, a left-sided arteriovenous fistula, or a history of ipsilateral hemodialysis catheter placement.

Facial edema associated to central vein stenosis in a chronic kidney disease patient

Facial edema associated to central vein stenosis in a chronic kidney disease patient

Cavoatrial junction stenting in vascular hemodialysis catheter malfunction.

In patients undergoing hemodialytic treatment via intravascular catheters, stenosis or occlusion of central veins is common. Despite an extensive characterization of Superior Vena Cava Syndrome (SVCS) no data is available about CavoAtrial Junction (CAJ) stenosis. We report the case of two patients with a story of multiple catheter failures due to thrombosis or infection. Computed tomography (CT) showed radiological signs of CAJ stenosis confirmed at the following venography. In absence of other feasible options to place a vascular access, the two underwent stenting with Gore Viabahn VBX balloon expandable endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ, USA) of the CAJ stenosis. Completion venography showed complete resolution of the stenosis in both patients. No complications occurred during the procedures. At a mean follow-up of 878 ± 559 days no signs of in-stent restenosis or recoil were found. The present cases emphasize the feasibility and safety of CAJ stenting, underlining the importance of preserving CAJ and upper veins patency in hemodialysis access.

Snuffbox Versus Wrist Radiocephalic Arteriovenous Fistulas: 10 Years Experience.

Background The wrist radiocephalic arteriovenous fistula (RCAVF) is the initial suggested procedure for establishing hemodialysis vascular access (HVA) in the most distal site of the upper limb. The anatomical snuffbox arteriovenous fistula (SBAVF) is barely utilised, despite its remote location. In this study, we aimed to analyse and compare the results of SBAVF and RCAVF in terms of their maturity, patency, and failure rates. Methodology This descriptive, retrospective study compared outcomes between SBAVF and RCAVF in terms of maturation, patency, and failure. All patients with chronic kidney disease who attended and underwent either procedure at Betsi Cadwaladr University Health Board between 2013 and 2023 were studied. Results In a period of 10 years, 179 patients were included. Overall, 102 (57%) were male and 77 (43%) were female, with a male-to-female ratio of 1.3:1. Wrist radiocephalic fistula was the dominant type of surgery done in 76% (n = 136), while the snuffbox radiocephalic fistula was done in fewer than 24% (n = 43) of patients. Most patients underwent a successful arteriovenous (AV) fistula (n = 105, 58.7%), in contrast to 67 patients whose fistulas failed. There was a significant relationship between fistula failure and complications (p = 0.000). There was no significant effect of the fistula site, hypertension, diabetes, cardiac diseases, smoking, peripheral vascular disease, or central vein stenosis on the failure of the AV fistula (p = 0.127, 0.534, 0.510, 0.397, 0.017, 0.68, and 0.371, respectively). Conclusions The snuffbox AV fistula is a suitable and feasible first choice for patients on hemodynamic therapy.

An Uncoventional Technique: Outflow Vein Tributary access for Central Vein and Cephalic Arch Angioplasty in Dysfunctional AVF

Abstract Introduction: Central venous stenosis (CVS) is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the HD access circuit. In CVS, dialysis through an arteriovenous (AV) fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Interventions for central vein stenosis in patients with AV access are typically performed with a direct puncture of the fistula outflow vein or taking access from the femoral vein, jugular vein, axillary vein, and basilic vein. Commonly encountered complications with taking access from the fistula vein-puncture site bleeding, hematoma, pseudoaneurysm, thrombosis of arteriovenous fistula; complications noted with femoral vein access are groin hematoma, lower limb deep-vein thrombosis, need for patient immobilization, and groin compression. An alternative approach is to use the outflow vein tributary, such as the cephalic vein tributary, as an access to avoid these potential complications. Aim and Objective: The objective of this study was to evaluate the feasibility and clinical outcomes of central vein and cephalic vein arch angioplasty, utilizing an outflow vein tributary as access, for managing symptomatic CVS in dialysis patients with upper limb vascular access and significant ipsilateral limb edema. Methodology: In a Prospective interventional study conducted at 2 Tertiary care Institutes between 2022 and 2023, a total of 34 patients underwent central vein and cephalic arch angioplasty utilizing an outflow vein tributary as access. Follow-up duration varied among patients. Results: During a 1-year period, a total of 34 patients (20 male and 14 female) underwent interventions for central vein stenosis using a tributary of the outflow vein as an access. These interventions encompassed lesions in the SVC, innominate vein, subclavian vein, cephalic arch, and multisegmental disease. The technical success rate for endovascular treatment stood at 88%. However, in four patients, we encountered difficulties in crossing the lesion despite employing additional access from the great saphenous vein (GSV). Notably, in 23 cases, the entire procedure was successfully completed using access from the tributary vein, whereas in seven patients, supplementary access was obtained from the right GSV. Importantly, none of the patients experienced access site complications. Conclusion: The use of tributary veins as access allows for the use of wide bore sheaths without encountering complications when addressing central vein pathology. Our findings indicate that employing outflow vein tributaries as access for endovascular treatment is both safe and effective in managing central venous disease.

Successful management of fatal cardiac tamponade resulting from intravascular intervention for central vein occlusion in hemodialysis patients: A case report.

This case report highlights the successful management of fatal cardiac tamponade caused by intravascular intervention for central vein occlusion in hemodialysis patients. Prompt diagnosis and treatment are essential for patient prognosis in such cases. We present a case involving a challenging surgical procedure to address multiple complications, emphasizing the importance of early detection and appropriate interventions. The patient, who had a history of long-term central venous catheter use for hemodialysis, was diagnosed with central vein stenosis in addition to superior vena cava occlusion, hemodialysis catheter rupture, hypertension, and end-stage renal disease. Urgent ultrasound examination during surgery revealed pericardial effusion, prompting immediate pericardial drainage for stabilization. To overcome the complex challenges, we successfully performed an innominate vein-right atrial appendage bypass to restore vascular access and salvage the patient's life. The timely use of echocardiography for diagnosis and pericardial drainage contributed to stabilizing the patient's vital signs, providing an opportunity for subsequent surgical intervention. The innominate vein-right atrial appendage bypass procedure successfully relieved central vein stenosis and saved the patient's life. Although this surgical technique is not widely documented in hemodialysis patients with central venous involvement, it show cases the potential benefits for clinicians managing vascular access in this patient population. This case report underscores the need for awareness among clinicians regarding the risk of cardiac tamponade associated with intravascular intervention for central vein stenosis in hemodialysis patients. Minimizing central venous catheterization and prioritizing autogenous arteriovenous fistulas are crucial principles in preparing vascular access for hemodialysis patients. Early detection, timely interventions, and consideration of alternative surgical techniques can improve outcomes and prevent life-threatening complications.

Fatal superior vena cava rupture complicating dialysis catheter exchange.

Central vein stenosis (CVS) is a common and challenging complication in hemodialysis patients with chronic central venous catheters (CVCs). CVS often remains asymptomatic and is discovered incidentally during follow-up imaging. CVS symptoms include arm swelling, venous hypertension, impaired dialysis flow rates, and development of collateral veins. However, these symptoms can be nonspecific and overlap with other conditions, making the diagnosis challenging. Timely recognition and appropriate intervention are crucial to prevent complications and optimize patient outcomes. Diagnostic tools commonly used include duplex ultrasonography and venography to assess the degree and location of stenosis. Management strategies for CVS encompass a multidisciplinary approach involving nephrologists, interventional radiologists, and vascular surgeons. Initial conservative measures may include anticoagulation therapy, along with pharmacological interventions such as antiplatelet agents and thrombolytics. The endovascular approach is the first line for managing CVS by using balloon angioplasty either alone or in combination with stent placement, but CVS typically recurs frequently, requiring repeated interventions with an increased risk of complications. Additionally, alternative vascular access options such as arteriovenous fistulas or grafts may be considered. In this report, we describe a case of a 25-year-old woman who presented with an extensive history of multiple dialysis access failure for left internal jugular vein central venous tunneled catheter exchange. The procedure was complicated by a fatal superior vena cava rupture likely related to the dislodgment of the guidewire causing perforation into the pericardium space with subsequent cardiopulmonary collapse. The post-mortem autopsy showed severe organized stenosis of SVC and transmural defect above the SVC/atrial junction.

Percutaneous Transluminal Angioplasty (PTA) and Stent Implantation in Hemodialysis Patients with Central Venous Stenosis:A Study of Outcomes

BACKGROUND: Central venous stenosis and occlusion are serious complications that can arise from central venous catheterization in hemodialysis patients, leading to significant difficulties in the dialysis process. Common clinical manifestations include swelling in the arm or neck on the affected side and compromised hemodialysis access. To address this issue, percutaneous balloon angioplasty and stent implantation have emerged as potential solutions to maintain vein patency. However, there is a need to evaluate the efficacy of these interventions over an extended period to determine their long-term benefits. This study aimed to monitor the patency status periodically, starting at 1st Month, followed by assessments at 3rd Month, 6th Month, and finally, the 12th Month. METHODS: This single-center observational study focused on endovascular interventions performed on hemodialysis patients with central venous stenosis or occlusion.Participants included end-stage renal failure patients undergoing hemodialysis who exhibited clinical signs of central venous stenosis or occlusion. Data were collected from 60 patients, consisting of 42 males (70%) and 18 females (30%), with an average age of 46.19±13.21 years. The affected sites of central vein stenosis or occlusion were distributed as follows: 13 cases in the innominate veins, 25 cases in the superior vena cava, 18 cases in the brachiocephalic vein, and 10 cases in the subclavian vein. Some patients had multiple site occlusions, while others experienced occlusion of AV fistula. RESULTS: Of the 60 endovascular procedures performed, only one case did not achieve technical success, resulting in an overall success rate of 96.4%. Stent implantation was carried out in only four patients. No significant procedure-related complications were encountered, and all patients were able to undergo hemodialysis after the initial intervention. The primary patency rates for PTA at 1, 3, 6, and 12 months were 96%, 92%, 88%, and 86%, respectively. As for stent implantation, the primary patency rates at 1, 3, 6, and 12 months were 100%, 98%, 98%, and 98%, respectively. Assisted primary patency rates for PTA at 1, 3, 6, and 12 months were 2%, 6%, 11%, and 14%, respectively. During the 12-month follow-up, 10 reinterventions were performed, with three patients requiring more than two reinterventions. CONCLUSION: The study's findings demonstrate that endovascular interventions, such as percutaneous balloon angioplasty and stent implantation, are highly effective in managing central venous stenosis or occlusion in hemodialysis patients. These interventions showed a remarkable success rate and a minimal occurrence of procedure-related complications. Particularly, stent implantation consistently exhibited 100% primary patency at all evaluated time points. While the assisted primary patency rates for PTA were relatively lower, the overall need for reinterventions remained low, emphasizing the long-term benefits of these procedures. Based on these promising results, endovascular interventions can be considered as a viable and efficient option for the management of central venous stenosis or occlusion in hemodialysis patients, offering improved hemodialysis access and ensuring enhanced patient outcomes.

Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies.

Central venous stenosis is a significant and frequently encountered problem in managing hemodialysis (HD) patients. Venous hypertension, often accompanied by severe symptoms, undermines the integrity of the hemodialysis access circuit. In central venous stenosis, dialysis through an arteriovenous fistula is usually inefficient, with high recirculation rates and prolonged bleeding after dialysis. Central vein stenosis is a known complication of indwelling intravascular and cardiac devices, such as peripherally inserted central catheters, long-term cuffed hemodialysis catheters, and pacemaker wires. Hence, preventing this challenging condition requires minimization of central venous catheter use. Endovascular interventions are the primary approach for treating central vein stenosis. Percutaneous angioplasty and stent placement may reestablish vascular function in cases of elastic and recurrent lesions. Currently, there is no consensus on the optimal treatment, as existing management approaches have a wide range of patency rates.

Assessment of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques: a simple solution to a complex problem.

The aim of this study was to evaluate the causes of the dysfunctional tunneled cuffed catheters (TCCs) using multi-spiral computed tomography venography (MSCTV), and to analyze the outcomes of endovascular salvage techniques. This retrospective review data from 27 patients who experienced TCC dysfunction between July 1, 2016 and January 31, 2021 was conducted. Patients' demographic data, clinical signs and symptoms, and imaging data were collected from interventional radiology database. MSCTV showed a range of abnormalities in the hemodialysis (HD) patients, including central venous occlusion (n = 4), fibrin sheath formation (n = 3), malposition of the catheter tips (n = 4), central venous perforation (n = 1), thrombus formation (n = 12), regular catheter exchange without determined lesions (n = 3). Interventional catheter salvage procedures were performed, such as catheter exchange, balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, and stent deployment. The technical success rate for catheter insertions was 100%, and no procedure-related severe complications were observed. The 30-day catheter patency for all assessable catheters was 85.2%. The use of MSCTV showed abnormal findings in almost 88.9% of cases concerning dysfunctional TCC. In this study, the examined appropriate endovascular techniques were found to be safe and technically successful, with a low incidence of procedure-related complications.

A rare case of an aortic arch stent causing central vein stenosis

Purpose Central vein stenosis is commonly encountered in end stage renal disease patients on hemodialysis. Most are manageable with repeated procedures and venoplasty, however in some cases, venoplasty may not be successful. Method We discuss a rare case of persistent upper limb swelling due to severe central vein stenosis from compression of an aortic arch stent. Result Despite attempt at prolonged balloon inflation during venoplasty of the central vein, the stenosis still persisted. The arteriovenous fistula was then ligated and other forms of vascular access for hemodialysis were sought after. Conclusion Central venograms may be useful in end stage renal failure patients as part of pre-operative arteriovenous fistula creation so as to anticipate the possibility of central vein stenosis and its associated complications.

Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction

Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction

Central venous stenosis after subclavian versus internal jugular dialysis catheter insertion (CITES) in adults in need of a temporary central dialysis catheter: study protocol for a two-arm, parallel-group, non-inferiority randomised controlled trial

BackgroundThe right internal jugular vein is currently recommended for temporary central dialysis catheters (tCDC) based on results from previous studies showing a lower incidence of central vein stenosis compared to the subclavian vein. Data is however conflicting, and there are several advantages when the subclavian route is used for tCDCs. This prospective, controlled, randomised, non-inferiority study aims to compare the incidence of post-catheterisation central vein stenosis between the right subclavian and the right internal jugular routes.MethodsAdult patients needing a tCDC will be included from several hospitals and randomised to either subclavian or internal jugular vein catheterisation with a silicone tCDC. Inclusion continues until 50 patients in each group have undergone a follow-up CT venography. The primary outcome is the incidence of post-catheterisation central vein stenosis detected by a CT venography performed 1.5 to 3 months after removal of the tCDC. Secondary outcomes include between-group comparisons of (I) the patients’ experience of discomfort and pain, (II) any dysfunction of the tCDC during use, (III) catheterisation success rate and (IV) the number of mechanical complications. Furthermore, the ability to detect central vein stenosis by a focused ultrasound examination will be evaluated using the CT venography as golden standard.DiscussionThe use of the subclavian route for tCDC placement has largely been abandoned due to older studies with various methodological issues. However, the subclavian route offers several advantages for the patient. This trial is designed to provide robust data on the incidence of central vein stenosis after silicone tCDC insertion in the era of ultrasound-guided catheterisations.Trial registrationClinicaltrials.gov; NCT04871568. Prospectively registered on May 4, 2021.

The Experience of Using Plain Balloon Percutaneous Venoplasty in Central Vein Stenosis in Hemodialysis Patient; Insight for Future Better Development Strategy

Background : Central vein stenosis is a most complication among hemodialysis patient who inserted catheter or access for dialysis. The proper management is still challenging because venoplasty as the main recommendation but it had potential complication. The comparable datas of plain vs drug coated balloon were still exist. In this case presentation we will discuss about the use of plain ballon venoplasty as an urgent strategy to relieved central vein stenosis in hemodialysis patient and it’s outcome after procedure in our hospital. Case : Female, 56 years old came to Saiful Anwar Hospital with unilateral upper extremity edema, she felt heavy to move her arm, a litte bit numbness, and no history of pain on her arm. She had been undergo routine hemodialysis and had history of AV shunt inserted for 3 months ago. She came with compos mentis, GCS 456, BP 160/92 mmHg, HR 68 bpm, RR 20 tpm, SpO2 98% RA, temp 36.4oC, Hb 8.0 mg/dL, Ur 53.6 mg/dL, Cr 5.4 mg/dL, eGFR 1.73. From physical examination we got good peripheral oxygen saturation, we suggested this patient with central vein stenosis. We performed venography resulted stenosis 95% at brachiocephalic vein and undergo plain balloon percutaneous venoplasty. After procedure her right upper extremity was getting better. We observes this patient, but in the next three months after procedure of plain balloon percutaneous venoplasty she complained that her right upper extremity became swollen again. We performed re-venography and resulted with restenosis of brachiocephalic vein. She underwent percutaneous venoplasty again and the evaluation untik now was better, the diameter of upper right extremity became smaller and she can do her daily activity. Conclusion : Central vein stenosis was one of the most complication after dialysis catheter insertion. We performed percutaneous venoplasty and observed the outcome of this patient. After 3 months, the symptom was recurrent and we performed percutaneous venoplasty again.

Most complex brachiocephalic vein occlusion in hemodialysis patients can be treated with simple endovascular techniques in an office-based angiosuite

ObjectiveBrachiocephalic vein (BCV) obstruction can cause dialysis access dysfunction and failure. Central vein stenosis involving the BCV may require advanced endovascular procedures. We report that most BCV occlusions can be treated using simple endovascular techniques on an outpatient basis. MethodsFrom January 2009 to January 2022, 115 hemodialysis patients underwent BCV endovascular revascularization. Seventy-three of the initial procedures were performed in an office-based angiosuite. Indications for the procedure were BCV occlusion endangering the performance of a previous arm access or making the creation of a new arm access unadvisable. We recorded and analyzed risk factors and procedural results, patency rates, complications, and mortality. ResultsThe median age was 62 years (range, 23-91 years); 56% were female. Most prevalent associated conditions were diabetes mellitus (61%) and hypertension (68%). Fifty-six patients (48.7%) presented with severe upper extremity edema ipsilateral to the side of pre-existing functioning access. Obstruction recanalization was effective using standard catheter and wire in 106 cases (92.1%) and transseptal needle in nine cases (7.8%), that included seven using inside-out procedure. Initial management of the BCV stenosis was percutaneous transluminal balloon angioplasty alone in 74 patients (64.3%), stenting in 33 (28.7%), and HeRO conduit in eight cases (7%). Treatment of other central venous lesions included 49 cases (42.6%). The procedure was successful in 99.1% of patients. No intraoperative complications occurred. All 92 patients with previous arm access maintained adequate performance (100%). In 22 of 23 patients (95.6%), new upper extremity access creation was effectively performed after the venous intervention. Overall clinical success rate was 92%. The mean postoperative monitoring was 23 months, the median was 12 months, and the range was 1 to 84 months. During this monitoring period, 266 endovascular procedures, 91% in the office and 9% in the hospital, were required to preserve access performance. Eventually, 49 patients (42.6%) were stented. Eleven patients (9.56%) had infections, and six required complete access removal. Other causes of access failure included two patients with central vein thrombosis and one with massive pulmonary embolus. At the end, nine patients (7.8%) had access failure. Thirty-two patients (27.8%) died of unrelated causes during the follow-up period. Seventy-six patients (66%) have maintained functional access. Kaplan-Meier curves determined median primary patency of 9.6 months, median primary assisted patency of 56.2 months, and secondary patency of 75% at 80 months. ConclusionsSuccessful endovascular revascularization of BCV obstruction can be treated safely, with simple endovascular techniques in an office-based context with minor complication rates and durable results.

The Effects of Protrusion into the Outflow Vein on Outcomes of Stent Grafts Used to Treat Cephalic Arch Stenoses in Dysfunctional Brachiocephalic Fistulae

PurposeTo assess long-term patency rates of cephalic arch stent grafts in brachiocephalic fistulae and the importance of device position. Materials and MethodsThis retrospective study reviewed 152 patients with dysfunctional brachiocephalic fistulae and cephalic arch stenosis treated with stent grafts (Viabahn; W. L. Gore) at a single tertiary center between 2012 and 2021. The median age was 67.5 years (range, 25–91 years), and the median follow-up period was 637 days (range, 3–3,368 days). A grading system of protrusion was applied: (a) Grade 0, no protrusion; (b) Grade 1, perpendicular; and (c) Grade 2, in-line protrusion. Subsequent fistulograms were available in 133 (88%) of the 152 patients and were assessed for central vein stenosis within 10 mm of the stent graft. Clinical records were assessed for sequelae of stent graft protrusion. Stent graft primary and cumulative circuit patencies were calculated using the Kaplan-Meier method. ResultsProtrusion was documented in 106 (70%) stent grafts—56 Grade 1 and 50 Grade 2. Central vein stenosis was seen in 1 (2%) case of no protrusion (Grade 0) and 38 (40%) cases of protrusion (P < .0001). There was no significant difference in stenosis between Grade 1 and 2 protrusion (P = .15). No adverse clinical sequelae occurred in 147 (97%) patients. Eight patients had a new access subsequently formed in the same arm, and 3 of these 8 patients developed symptoms due to the previous stent graft protrusion (all Grade 2). The primary patency rates of the stent-grafts at 6 and 12 months were 73% and 50%, respectively. The cumulative access circuit patency rates at 1, 2, and 5 years were 84%, 72%, and 54%, respectively. ConclusionsThis study demonstrated that protrusion of a cephalic arch stent graft into the central vein is safe and only clinically relevant when a subsequent ipsilateral access is created.

Abstract No. 97 Safety and Patency of Dedicated Venous Stents for Treatment of Thoracic Central Vein Stenosis Compared with Non-Venous Stents

Abstract No. 97 Safety and Patency of Dedicated Venous Stents for Treatment of Thoracic Central Vein Stenosis Compared with Non-Venous Stents

Characteristics of central vein stenosis patients at Abdoel Wahab Sjahranie Hospital Samarinda

Background: Central vein stenosis (CVS) is a common complication in using a central venous catheter in hemodialysis (HD) access, and its incidence in Indonesia has not been obtained. This study aims to evaluate the characteristics of CVS patients in Abdul Wahab Sjahranie Hospital, Samarinda. Methods: This cross-sectional descriptive study was conducted by collecting CVS patients’ data from the medical records between January 2018 to August 2021. The demographic data and the characteristics of CVS patients were collected. The data obtained were analyzed in descriptive form and displayed in a table. Results: This study involved 23 subjects. The characteristics of CVS patients included: Highest sex group was males (61%); Age group was in the range 51-70 years (60%); Clinical feature was swelling (83%); Site of stenosis was in the subclavian vein (87%), on the left side (57%), type of occlusion were partial (67%) and single (87%), and the result of angioplasty was a success (61%). Conclusion: This study showed that CVS was male predominant, in the range 51-70 years, the most complaint was swelling in the arms that were mostly on the left side, and the location of the most stenosis was in the subclavian vein, with partial and single occlusion, as well as good treatment with angioplasty.

Angioplasty-stenting vs. the Miller Procedure for Central Vein Stenosis in Hemodialysis Patients

Angioplasty-stenting vs. the Miller Procedure for Central Vein Stenosis in Hemodialysis Patients

Long-Term Outcome of a “Mother-Child” Coaxial Dual-Catheter Technique for Percutaneous Transluminal Angioplasty of Central Vein Stenosis or Occlusion in Hemodialysis Patients

Purpose: This study aims to evaluate the long-term outcome and prognostic factors of a “mother-child” coaxial dual-catheter technique for percutaneous transluminal angioplasty (PTA) in the treatment of central vein stenosis (CVS) or central vein occlusion (CVO). Materials and Methods: During September 2017 to August 2020, totally, 76 hemodialysis patients with symptomatic CVS or CVO were treated with PTA using the mother-child technique. The success rate, complications, and follow-up information were collected. Cox proportional hazard analysis was used to explore the predicting factors of primary patency. Primary patency rates of different subgroups were generated with the Kaplan-Meier analysis and compared using the log-rank (Mantel-Cox) test. Results: There were 31 CVS patients and 45 CVO patients who presented with 114 PTAs. The initial procedure success rate was 98.25%. By the end of the follow-up, 57 patients (75%) had maintained functioning fistula after initial or repeated PTAs. The primary patency rates were 88.75% at 3 months, 73.36% at 6 months, 55.83% at 12 months, and 50.75% at 18 months. The secondary patency rates were 97.14% at 6 months, 87.66% at 12 months, and 82.18% at 24 months. The predictors for primary patency were history diabetes mellitus (hazard ratio [HR] = 3.1, 95% confidence interval [CI]: 1.31-7.30, P = .010), abnormal white blood cell count (HR = 1.44, 95% CI: 1.18-1.75, P < .001), lesion at subclavian-innominate vein (HR=2.75, 95% CI: 1.34-5.63, P = .006), and occlusion (HR=0.33, 95% CI: 0.14-0.76, P = .010). The primary patency was significantly lower in the subclavian-innominate vein subgroup, with a median primary patency of 4.5 (3-12.75) months, than in the nonsubclavian-innominate vein subgroup (8.5 [5-13] months; P = .005). The median duration of each PTA was 8 months for the first PTA, 7.5 months for the second PTA, and 5 months for the third PTA. There was no significant difference in the patency duration of repeated PTAs and the primary PTA (P = .389). Conclusions: The mother-child coaxial dual-catheter technique has a good success rate and acceptable primary patency in the treatment of hemodialysis patients with CVS or CVO. Repeated PTA is as effective as the primary PTA. Clinical Impact This is the follow up report on the “Mother-Child” coaxial dual-catheter technique for percutaneous transluminal angioplasty of central vein stenosis or occlusion in hemodialysis patients since we first presented it in 2019. In this paper, we can see that the long-term patency rate of this technique for central venous disease is satisfactory, and repeated use of this technique does not affect the patency time. Compared with other literature reports, the surgical success rate of this technique is significantly improved. Therefore, this technique is worth popularizing in the treatment of central venous disease.