Endovascular management of central venous stenosis in hemodialysis patients

Abstract

Objectives The aim of this study was to assess the effectiveness of percutaneous transluminal angioplasty (PTA) with or without stent deployment for treatment of venous hypertension resulting from central venous stenosis (CVS) in hemodialysis (HD) patients and to determine the relationship between the temporary dialysis catheters and the type of the fistula from one side and development of CVS on the other side. Background The quality of life of HD patients depends mainly on the patency and proper function of their arteriovenous shunts. Vascular surgeons should have many surgical and endovascular plans to keep the hemodialysis access working properly, endovascular management of CVS is one of these plans. Patients and methods A prospective study in which 30 recruited patients with end-stage kidney disease on regular hemodialysis (HD) complaining of venous hypertension owing to CVS with functioning arteriovenous fistulas or arteriovenous grafts was carried out during the period from October 2015 to February 2017. Results Endovascular management through percutaneous transluminal angioplasty and/or stent deployment resulted in a significant higher fistula flow rate at 3 months (593.18 vs. 1964.54 ml/min; P = 0.05), and there was a significant improvement of patient symptoms and angiographic findings. Additionally, there was a higher incidence of CVS with past history of central veins cannulation and proximal arteriovenous fistulas. Conclusion Endovascular treatment of the CVS and venous hypertension whether by balloons and/or stents has a significant positive effect on the fistula flow and relief of venous hypertension symptoms in HD patients.