Venous spurs are found among about half of patients with left-sided iliac venous thrombosis. As long as the underlying venous pathologic process is left untreated, thrombectomy will not restore patency. Stent implantation is a simple and safe means to correct central venous strictures and provides excellent long-term results.

Central venous obstruction has become a major problem because of the frequent need for central venous catheters in haemodialysis patients. This article discusses the epidemiology and clinical features of central venous obstruction and the different surgical and interventional alternatives for its treatment.

Vascular access remains the Achilles heel of end-stage renal disease patients, receiving haemodialysis. The increase in the number of elderly dialysis patients with additional cardiovascular co-morbidities and diabetes mellitus makes the creation and maintenance of functioning vascular access, more difficult and cumbersome. Therefore, the development of guidelines for vascular access management seems logical. A team of multidisciplinary vascular access experts created a set of algorithms covering the whole spectrum from pre-operative vessel assessment, peri-operative access management and post-operative follow up and surveillance. Additionally, a range of various access complications with their diagnosis and treatment options were included in these algorithms. The new European guidelines for vascular access augment the knowledge of vascular access problems and their management. Additionally, the use of algorithms facilitates the decision-making when treating complications by all physicians dedicated to this field of healthcare.

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Complete operative correction of DAAC usually can be accomplished as a single-stage procedure with low morbidity and mortality rates. The reconstruction of all renal arteries is essential to cure hypertension. Consequent follow-up is recommended for detection of late postoperative complications.

From November 1992 through July 1996, 15 Wallstents were implanted for the treatment of symptomatic central arm vein obstructions in 14 hemodialysis patients (10 subclavian, 2 brachiocephalic vein stenoses, 2 subclavian vein occlusions). There were no acute complications. All patients were investigated by clinical examination and color-duplex sonography at regular three month intervals. When recurrent swelling predicted restenosis, phlebography was also performed. During the follow-up, high grade stenoses at the central or peripheral ends of four stents were successfully treated with five overlapping stents, giving a total of 20 Wallstent implantations. Complete occlusion of another subclavian vein distally to the stent at 16 months required ligation of the patient's arteriovenous fistula. Life table analysis including all 20 stents revealed a cumulative primary one year (two year) stent patency of 70% (50%). The cumulative secondary one year (two year) stent patency was 100% (85%). We believe that in hemodialysis patients, PTA plus Wallstent implantation is a safe and effective procedure in the treatment of central venous stenoses and even shorter occlusions. Consequent follow-up allows for timely diagnosis and treatment of restenoses, thus guaranteeing long-term patency rates comparable to those of veno-venous bypass surgery.