Treatment of Central Venous Stenosis in Hemodialysis Patients with Percutaneous Transluminal Angioplasty

Abstract

Central venous stenosis has emerged as a significant clinical problem in hemodialysis patients. Endovascular interventions, including percutaneous transluminal angioplasty (PTA), have gained popularity for the initial treatment of venous hypertension due to central venous lesions. The purpose of our study was to evaluate the efficacy of PTA for the treatment of central venous stenosis or occlusion in patients undergoing hemodialysis. We retrospectively identified 17 hemodialysis patients (9 men and 8 women with a mean age of 64 years) who had central venous lesions treated by PTA. The lesions involved the axillary, subclavian, and innominate veins with complete occlusion in 3 cases. The procedure of PTA was a technical success without complications in all cases.The mean follow-up was 23 months (range, 1-67 months). The cumulative primary patency rates were 85.7%, 78.6%, 44.2%, and 33.1% at 6, 12, 24, and 36 months, respectively. The cumulative secondary patency rates were 100% at 6 and 12 months, and 90.9%, 77.9% at 24 and 36 months.In conclusion, percutaneous central venous angioplasty can provide symptomatic relief and restore the functionality of the vascular access in hemodialysis patients. Although multiple procedures are often required, PTA would be a first-line approach in this condition, in terms of its safety and minimal invasiveness.