Treatment Of Central Venous Obstruction Research Articles

Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis - Preliminary experience in a tertiary care center.

Background:Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency.Aim:To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis.Settings and Design:This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable.Materials and Methods:Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively.Results and Conclusion:A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease.

Long-Term Results of Angioplasty and Stent Placement for Treatment of Central Venous Obstruction in 126 Hemodialysis Patients: A 10-Year Single-Center Experience

The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients. Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment. The primary treatment was angioplasty, and stent placement was accomplished in angioplasty-resistant obstructions. Angioplasty was the primary treatment of recurrence after stent placement. Additional stenting was reserved for angioplasty-resistant recurrences. One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions. Endovascular treatment of central venous obstruction is a safe and effective procedure in hemodialysis patients. Stenting has a significantly lower primary patency rate than angioplasty but adds to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in angioplasty-resistant lesions.

Axillary to saphenous vein bypass for treatment of central venous obstruction in patients receiving dialysis

Venous hypertension due to subclavian or innominate vein stenosis coexisting with a functioning arteriovenous access in the ipsilateral arm is a complex problem in patients undergoing hemodialysis. Therapeutic solutions must optimally relieve symptoms, permit use of the angioaccess, and carry minimal surgical risk. The purpose of this study was to evaluate a simple surgical option, bypassing central venous obstruction to the great saphenous vein. Eight patients undergoing hemodialysis with severe symptoms and signs of venous hypertension due to subclavian or innominate vein obstruction and ipsilateral arteriovenous fistula or graft underwent axillosaphenous bypass via a subcutaneous 8-mm polytetrafluoroethylene bridge graft. No intraoperative or immediate postoperative morbidity was observed. Early and 6-month patency rates were 100% and 87.5%, respectively. All patients reported improvement of symptoms, and the angioaccess was usable in all cases. Average follow-up was 21.5 months. One patient had a relapse at 5 months, which necessitated revision of the graft-saphenous vein anastomosis. Bypassing a central vein occlusion to the saphenous vein relieves symptoms of venous hypertension and prolongs use of the hemodialysis angioaccess.

Central Venous Obstruction in Hemodialysis Patients: The Usefulness of Percutaneous Treatment

Purpose: To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. Materials and Methods: In 100 patients, 107 central venous strictures [56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23, stenosis:28)] were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion were also determined. Results: We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2- and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). Conclusion: In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.

Comparison of Surgical Bypass and Percutaneous Balloon Dilatation With Primary Stent Placement in the Treatment of Central Venous Obstruction in the Dialysis Patient: One-Year Follow-up

Central venous stenosis and occlusion are complications that are being observed with increasing frequency as a result of the use of long-term central venous catheters. These complications are especially problematic in patients with end-stage renal disease and functioning ipsilateral arteriovenous (AV) grafts or fistulas (AV grafts). We have previously demonstrated that the 1-year patency rate for simple balloon angioplasty in these patients is less than 10%. To compare the results of surgical treatment vs. percutaneous dilatation with stent placement, we undertook this retrospective study. All patients underwent multiple central venous catheter placements and had functioning ipsilateral AV grafts. Twenty-six patients were divided into two groups. The surgical treatment group included 13 patients: 10 with subclavian vein thrombosis and three with innominate vein thrombosis. All patients in the surgical group had arm swelling and edema. Surgical bypass procedures were performed in these patients using either polytetrafluoroethylene or saphenous vein. The stent group also included 13 patients; all of them had a diagnosis of subclavian or innominate vein obstruction and were treated with percutaneous transluminal angioplasty and placement of either a self-expanding rigid stent (n = 6) or a balloon-expandable flexible stent (n = 7). Two patients required multiple stent placements. No significant complications occurred in either group. The 1-year mortality rate in both groups was 31%. The percentages of patients who were symptom free at 6 and 12 months were also similar in the two groups. We conclude that surgical bypass and percutaneous transluminal angioplasty with stent placement are both efficacious in the treatment of central venous obstruction.