Endovascular treatment of occlusive central venous disease: one center's experience

Abstract

Introduction: The majority of cases of stenosis or occlusion of central veins are the result of central catheters, arteriovenous fistulas, neoplasms or traumas and these conditions can cause severe cases of venous hypertension or reduce the flow through fistulas. The objective of this study is to analyze the results of central venous angioplasties conducted at our hospital. Methodology: We conducted a retrospective and descriptive study to analyze the results of central venous angioplasties conducted from 2010 to 2012 at a university hospital run by the Universidade Estadual de Londrina, Brazil. We calculated primary and secondary success rates and analyzed whether or not stents were used and complications occurred during a 6-month follow-up period. Results: A total of 25 central venous angioplasties were conducted. Twenty-four (96%) of these were because of catheter-related intimal hyperplasia and one was to treat the effects of compression by a tumor. Fifteen (60%) angioplasties were to correct stenosis and ten (40%) were because of occlusions, with a one-hundred percent success rate for all stenosis-related procedures. However, none of the cases of occlusion could be treated endovascularly. Patency during the 6-months follow-up period was 80% after reinterventions. Conclusions: Despite good results observed after primary interventions for stenoses, it must be accepted that all current treatment options for chronic occlusive venous disease will, sooner or later, lead to restenosis or occlusion. Venous occlusions constitute a challenge demanding the development of new techniques and new materials. Prevention is paramount, through avoidance of central catheterization and early creation of arteriovenous fistulas.

Outcome of Central Vein Occlusion Recanalization in Hemodialysis Patients and Predictors for Success: A Retrospective Study

“…In this study, the technical success rate of conventional recanalization was similar to that of previous studies [9,11,13,14]. The primary and assisted primary patency rates were also similar to previous reports [9,10,14].…”

“…Additionally, most of the cases in each study were CVS (Table 4). This is likely the reason for the low technical success rate in our study, though the success rates of conventional recanalization of CVO cases only in previous studies ranged from 0% to 100% [9,11,13,14]. Similarly to previous studies, failure to pass the guidewire across the occluded segment was the main etiology of technical failure in our study, owing to thickened fibrous tissue and calcification [9,11,13,14].…”

“…This is likely the reason for the low technical success rate in our study, though the success rates of conventional recanalization of CVO cases only in previous studies ranged from 0% to 100% [9,11,13,14]. Similarly to previous studies, failure to pass the guidewire across the occluded segment was the main etiology of technical failure in our study, owing to thickened fibrous tissue and calcification [9,11,13,14]. Many advanced techniques used to improve the technical failure rates have been reported, including sharp recanalization using the back end of the guidewire or a needle [7].…”

“…Additionally, a radiofrequency guidewire was used when the conventional technique failed [15]. However, we have not used these techniques since they are less available and aggressive, leading to excess morbidity and mortality [11]. The overall primary and assisted primary patency rates of endovascular recanalization are broadly variable in several studies.…”

“…Other advanced techniques that use the stiff backend of a guidewire or long needles can be considered when the standard technique fails [7]. The previous literature reported the success and patency rates of endovascular treatment in a combination of cases of CVS and CVO [3][4][5][6][8][9][10][11]. There are no reported data on endovascular outcome in hemodialysis patients with CVO only, and the predictive factors were not determined for recanalization success.…”