Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

Abstract

Aim To assess the effectiveness and predictive factors of stent grafts (SGs) for the treatment of central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access. Methods HD patients with CVOD who underwent SGs at our center between August 2018 and June 2022 were enrolled. The Kaplan–Meier method and log-rank test were used for survival curve analysis. SGs. Results 59 SG implantation procedures for CVOD were analyzed using Cox proportional hazards regression for the predictive factor analysis. Thirty subjects had stenosis and 29 had occlusion. The access circuit primary patency (ACPP) after SG placement at 6, 12, and 24 months was 80.9%, 53.8%, and 31.4%, respectively. The target lesion primary patency (TLPP) after SG placement at 6, 12, and 24 months were 91.3%, 67.6%, and 44.5%, respectively. In the subgroup analysis, the TLPP was higher in the stenosis group than in the occlusion group, but the difference was not significant (P = 0.165). The TLPP of procedures post-SG placement was significantly improved compared to that before SG placement (P < 0.001). Cox proportional hazards regression showed that a target lesion length ≥ 30 mm and procedural defects were independently associated with a lower TLPP after SG treatment for CVOD in HD patients. Conclusion SG placement is safe and effective for the treatment of CVOD in HD patients. SG improves the TLPP of endovascular therapy (EVT) for CVOD. A target lesion length ≥ 30 mm and procedure defects were predictive factors for TLPP.