Balloon Expandable Stents to Treat Central Venous Stenoses in Hemodialysis Patients

Abstract

Vascular access failure in hemodialysis patients remains a significant problem. The use of thrombolytic agents and balloon angioplasty instead of or in conjunction with surgical revision, has been helpful in increasing the life span of vascular access in these patients. The application of newer endovascular therapies, such as vascular stents, may further improve the salvage rate of hemodialysis access sites. These stents may be particularly valuable in treating stenoses in large central veins. We present 2 cases in which a balloon-expandable Palmaz® stent was used to treat a central venous stenosis causing signs of vascular access failure.

Intravascular ultrasound‐guided central vein angioplasty and stenting without the use of radiographic contrast agents

“…Central vein angioplasty followed by deployment of self-expanding or balloon-expandable metallic stents has been performed for more than a decade. 8,9 Angioplasty and stenting of symptomatic central vein stenosis in dialysis patients is associated with excellent procedural success rates, 8,10,11 and these interventions effectively maintain function of the dialysis conduit. 12 Unfortunately, even with stenting there is a high rate of recurrence and reintervention to maintain patency.…”

Efficacy of color flow duplex imaging for proximal upper extremity venous outflow obstruction in hemodialysis patients

“…Furthermore, correction of underlying proximal venous obstruction using endovascular or surgical techniques may improve shunt patency. 2,6,21,22 Therefore, CFDI is recommended as the initial imaging study (1) in all hemodialysis patients with extremity symptoms, (2) in all hemodialysis patients with failing or occluded permanent upper extremity hemodialysis access, and (3) before placement of a new arteriovenous shunt in patients who have had a prior ipsilateral temporary hemodialysis catheter. Contrast venography should be reserved for patients with (1) recurrent hemodialysis access failure despite a normal duplex scan, (2) proximal venous outflow obstruction identified by means of CFDI before pos- sible endovascular or surgical intervention, and (3) other dialysis graft problems, ie, venous or arterial anastomotic stenosis or more distal segmental venous obstruction.…”

Hemodialysis Catheter‐Associated Central Venous Stenosis

“…Several other investigations have been published which suffer from a number of limitations (45–53). These limitations include small number of interventions, observational rather than controlled methodology, and a lack of uniform indication for stent placement.…”

“…However, long-term symptomatic relief can be achieved with multiple subsequent interventions in many patients (44). Several other investigations have been published which suffer from a number of limitations (45)(46)(47)(48)(49)(50)(51)(52)(53). These limitations include small number of interventions, observational rather than controlled methodology, and a lack of uniform indication for stent placement.…”