Central vein stenosis: a common problem in patients on hemodialysis

Central vein stenosis (CVS) has been associated with subclavian (SCV) catheter insertions. The prevalence of CVS in the current era with minimal use of SCV catheters is unknown. Furthermore, the prevalence of CVS in patients with access problems has not been previously described to our knowledge. We evaluated 235 prevalent patients on hemodialysis (HD), and, of these, 133 underwent venography for access related concerns over a 14 month period. Of these 133 patients, 55 (41%) had evidence of significant CVS on venogram. Patients with CVS had a longer duration on HD (43 +/- 12 months vs. 34 +/- 15 months, p = 0.018) and a history of a previous HD catheter insertion (52/55 patients vs. 59/78 patients, p = 0.0039). There were only 18 patients with a subclavian catheter insertion. In those with any history of previous HD catheter insertion, multivariate analysis demonstrated that number of catheters remains a significant factor (OR 2.69, p = 0.0004) even after excluding those subclavian insertions. This study demonstrates that CVS occurs in almost half of the patients with access problems undergoing venography. We confirm the important contribution of central vein cannulation to CVS and show that, despite minimizing subclavian catheter insertion, CVS remains a relatively common occurrence. Thus further studies should attempt to determine the true incidence of this problem and ultimately address the optimal treatment strategies.