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Percutaneous treatment of symptomatic central venous stenosis [corrected]
L Richard Sprouse1, Christopher J Lesar, George H Meier
1Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA 23510, USA. lrsii@msn.com
Insights
Central venous occlusive disease (CVOD) is a growing problem, often linked to hemodialysis access. Percutaneous venous angioplasty offers temporary relief but frequently requires repeat procedures for long-term success.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Central venous access, particularly for hemodialysis, is increasing.
- This has led to a rise in central venous occlusive disease (CVOD).
- Optimal management strategies for CVOD remain unclear.
Purpose of the Study:
- To define the scope of central venous occlusive disease (CVOD).
- To evaluate the effectiveness of percutaneous interventions for CVOD.
- To assess the long-term patency of treated central veins.
Main Methods:
- Venography was used to evaluate patients with symptoms of central venous stenosis or occlusion.
- Percutaneous venous angioplasty (PTA) and/or stent placement was performed.
- Therapeutic success and recurrence rates were monitored during follow-up.
Main Results:
- 87% of lesions were hemodialysis-related; 13% were catheter-related.
- Percutaneous interventions were technically successful in 100% of cases.
- Symptomatic relief lasted an average of 6.5 months, with 63% requiring repeat PTA.
Conclusions:
- Central venous occlusive disease (CVOD) is a significant clinical issue.
- Percutaneous venous angioplasty provides temporary symptom relief.
- Long-term success is limited, often necessitating multiple interventions.
Objectives:
The increased use of central venous access primarily for hemodialysis has led to a significant increase in clinically relevant central venous occlusive disease (CVOD). The magnitude of and the optimal therapy for CVOD are not clearly established. The purpose of this study is to define the problem of CVOD and determine the success of percutaneous therapy for relieving symptoms and maintaining central venous patency.
Methods:
Patients presenting with disabling upper-extremity edema suggestive of central venous stenosis or occlusion during a 3-year period were evaluated by venography of the upper extremity and central veins. Percutaneous venous angioplasty (PTA) and/or stent placement was performed as clinically indicated. The success of therapy was assessed, and the patients were observed to determine the incidence of recurrence and additional procedures. Recurrent lesions underwent similar evaluation and treatment.
Results:
A total of 32 sides were treated in 29 patients with a mean of 1.9 interventions per side treated. Hemodialysis-related lesions were the underlying cause in 87% with the remaining 13% related to previous central venous catheterization. The lesions involved the axillary, subclavian, and innominate veins with complete venous occlusion in six (19%) cases. Percutaneous angioplasty was followed by stent placement in six (19%) cases. The procedure was a technical success and was performed without complications in all cases (100%). Mean follow-up was 16.5 months (range, 4-36 months). On average, patient symptoms were controlled for 6.5 months after the initial intervention. Recurrent edema led to additional PTA in 20 (63%) cases. Fifty percent (n = 14) of patients with an arteriovenous fistula (AVF) experienced recurrent symptoms after initial and/or repeat PTA and required AVF ligation. Complete resolution after the initial PTA was predictive of long-term success.
Conclusions:
Central venous occlusive disease has emerged as a significant clinical problem. Percutaneous venous angioplasty can provide temporary symptomatic relief; however, multiple procedures are often required and long-term relief is rarely achieved.
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