One-year outcomes and predictive factors for primary patency after stent placement for treatment of central venous occlusive disease in hemodialysis patients

Chen, Bin; Lin, Run; Dai, Haitao; Yang, Jun; Tang, Keyu; Li, Nan; Huang, Yonghui

doi:10.1177/20406223211063039

Cited by 7 publications

(9 citation statements)

References 33 publications

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“…Table 2 lists a few studies that reported data on the safety and effectiveness of CS. Furthermore, a study by Chen et al ( 27 ) reported that the use of CS (Viabahn ® , W. L. Gore & Associates Inc., Flagstaff, AZ, USA) was an independent predictor for better primary patency rates. The CS favorable outcomes can be attributed to the inherent mechanism of prohibiting in-stent intimal hyperplasia formation via the covered design, thus, reducing the need for additional patency maintaining interventions vis-à-vis the BMS.…”

Section: Discussionmentioning

confidence: 99%

“…Boutrous et al ( 26 ) showed that a longer stent is associated with decreased patency rates (62.5 vs. 50 centimeters; P=0.002). In another study, larger vessel diameters (i.e., >12 mm) had higher primary patency rates as stents with larger diameters were used ( 27 ). Based on our previous experiences, for isolated innominate lesions, we would use either Bard Fluency Plus (BD Interventional, Franklin Lakes, NJ, USA) or Atrium iCAST (Hudson, NH, USA), both of which provide a benefit of accuracy for device deployment.…”

Section: Discussionmentioning

confidence: 99%

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Management of concomitant central venous disease

Alnahhal¹,

Rowse²,

Kirksey³

2023

Cardiovasc Diagn Ther

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Symptomatic central venous disease (CVD) is a significant common problem in patients with end-stage renal disease given its adverse impact on hemodialysis (HD) vascular access (VA). The current mainstay management is percutaneous transluminal angioplasty (PTA) with or without stenting which is typically reserved for unsatisfactory angioplasty or more challenging lesions. Despite factors such as target vein diameters and lengths and vessel tortuosity that may determine the choice of bare-metal versus covered stents (CS), current scientific literature is pointing out the superiority of the latter one. Alternative management options such as hemodialysis reliable outflow (HeRO) graft showed favorable results in terms of high patency rates and fewer infections, however, complications such as a steal syndrome and, to a lesser extent, graft migration and separation are major concerns. The surgical reconstruction approaches such as bypass, patch venoplasty, or chest wall arteriovenous graft with or without endovascular interventions as a hybrid procedure are still viable options and may be considered. However, further long-term investigations are needed to highlight the comparative outcomes of these approaches. Open surgery might be an alternative before proceeding to more unfavorable approaches such as lower extremity vascular access (LEVA). The appropriate therapy should be selected based upon a patient-centered interdisciplinary discussion utilizing the locally available expertise in the area of VA creation and maintenance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of concomitant central venous disease

Alnahhal¹,

Rowse²,

Kirksey³

2023

Cardiovasc Diagn Ther

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“…The classic description is mostly in younger population and can present with venous thrombosis or intermittent symptomatic obstruction. Compression of neurologic structures is most common with a relative incidence of 80%, followed by venous (19%) and arterial (2%) [1]. Although the same anatomic predisposition can exist in dialysis patients, there is an added feature that is not present in the classic VTOS patients; namely the increased flow (venous return) from the upper extremity because of the HD acces which dilates the venous structures.…”

Section: Introductionmentioning

confidence: 99%

“…This subclavian venous occlusive disease poses a continuing and significant burden to patients undergoing long-term hemodialysis, causing ipsilateral limb swelling, and potentially access dysfunction related to venous hypertension. 1 The incidence of this VTOS like condition in hemodialysis patients has been increasing, so efficient management of this condition is essential [1]. Dialysis-related central stenosis can be due to multiple contributing factors, including catheter placement, venous flow, and compressive anatomy, leading to upper extremity HD access dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Viatorr Stent at the Thoracic Outlet to Maintain Hemodialysis Access Function

Ghasemi-Rad

Collard

et al. 2023

Vasc Endovascular Surg

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Purpose Venous steno-occlusive disease at the thoracic outlet affects up to 30% of the hemodialysis population [1] causing arm swelling and hemodialysis access dysfunction. Balloon angioplasty in this region can be of limited utility given the rigid compressive effect of surrounding musculoskeletal (MSK) structures. Outcomes of using the Viatorr endoprosthesis (Gore Viatorr TIPS Endoprosthesis, Gore, Flagstaff AR, USA, Viatorr ®) within this region to salvage the HD access in patients who presented with dialysis access dysfunction is presented. Methods A retrospective chart review was performed of our tertiary and quaternary care hospital system. Hemodialysis patients were included in the study if they were using an upper extremity arteriovenous fistula or graft for access, had a Viatorr stent placed in the central (subclavian and/or brachiocephalic) veins, and had follow up. Results A total of nine patients were identified to meet the inclusion criteria. Four interventions were due to refractory lesions of the subclavian or brachiocephalic veins, and the other five interventions were for hemodynamically significant lesions refractory to angioplasty alone, all resulting in access dysfunction. Primary patency ranged from 36-442 days (geometric mean 156.6 days, range 19-442 days). No stent fracture was identified on imaging at any point during follow-up of these patients out to a maximum of 2912 days (Average 837 days). Conclusions The Viatorr stent graft used in the HD population for clinically significant lesions at the thoracic outlet (TO) showed no structural failures (fractures) in this cohort.

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