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

Abstract

Background: Catheter-directed treatment is the standard approach for the management of chronic central venous occlusion. Purpose: The objective of this study is to report the outcome of conventional recanalization of chronic central vein occlusion in hemodialysis patients and to determine the predictors for success. Material and Methods: All hemodialysis patients who underwent endovascular recanalization of central vein occlusion from January 2012 to December 2016 were retrospectively evaluated. The procedure was percutaneous transluminal angioplasty. Stenting was performed in case of a significant recoil stenosis. Kaplan-Meier analysis was used to evaluate central vein patency. Univariate analysis and multivariate logistic regression were used to calculate the predictive factors. Results: Ninety-seven patients (mean age, 61.2 years; range, 25-89 years old) with 97 central vein occlusions were enrolled. Technical success was achieved in 49 patients (50.5%). The primary patency rates of central veins at 6 and 12 months were achieved in 17 patients (34.4%) and 8 patients (15.8%), respectively. The assisted primary patency rates at 6 and 12 months were achieved in 38 patients (77.3%) and 30 patients (61%), respectively. Patient age ≥60 years and a tapered-type of lesion were significant predictive factors for successful recanalization. Conclusion: Endovascular treatment of the central vein occlusion using a conventional technique is moderately effective and safe. Angioplasty alone and stenting were not significantly different in terms of patency rate. The age of the patients and type of occlusion were significant predictors for successful recanalization.

Clinical Implications of Phenotypes of Hemodialysis Patients With Central Venous Occlusion or Central Venous Stenosis Defined by Cluster Analysis

“…In terms of postoperative patency, there was a significant difference in the primary patency rate between the group with blunt stump and the group without blunt stump and also between the group with occlusion lesions ≥2 cm and the group with occlusion lesions <2 cm. A previous study of Hongsakul et al ( 12 ) on the relationship between the type of occlusion and the difficulty of CVO recanalization showed a significantly lower technique success rate for abrupt-type occlusion, which is also known as lesions with the blunt stump in this study. Keerati Hongsakul et al believed that the tapered-type occlusion indicates a recent occlusion.…”

The efficacy and safety of blunt impingement followed by a sharp recanalization technique in hemodialysis patients with refractory central vein occlusion: a single-center experience

“…The key to endovascular treatment is guidewire passage through the occluded segment. However, in 42-49% of patients, there is a failure to cross lesions of the central vein using standard guidewire and catheter techniques (11,19). This is the first report to discuss the efficacy and safety of blunt impingement followed by the sharp recanalization in hemodialysis patients with CVO.…”

Complex central venous catheter for dialysis: interventional radiology experience in insertion and management of their complications

“…It is very important to breakdown the fibrin sheath with progressive PTA 8 to preserve the venous axis for a possible future reuse of the access and, in our treatments, we generally avoided the use of a stent in the first instance, trying to obtain a satisfactory result only with the PTA, even using drug-eluting balloon – DEB (to ensure a longer lasting efficacy of the treatment and vascular patency), as also performed by other authors in the same district 18,21,22 (Figure 5).…”