Central venous disease in hemodialysis patients: an update

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Central venous occlusive disease (CVD) is a significant complication for hemodialysis patients.
• Existing endovascular treatments like angioplasty and bare-metal stenting offer limited long-term patency.
• Recalcitrant CVD necessitates exploring novel therapeutic strategies.

Purpose of the Study:

• To provide an updated review of current literature on Central Venous Occlusive Disease (CVD) treatment modalities.
• To assess the efficacy of recently proposed treatments, including covered stents.
• To consider newly proposed algorithms for the surgical management of CVD.

Main Methods:

• Comprehensive literature review of endovascular and surgical treatments for CVD.
• Analysis of studies evaluating covered stents for recalcitrant central venous stenosis and obstruction.
• Examination of proposed surgical management algorithms.

Main Results:

• Traditional endovascular treatments show suboptimal long-term patency rates.
• Covered stents demonstrate potential for improved outcomes in complex CVD cases.
• New surgical algorithms offer alternative management pathways.

Conclusions:

• There is a need for improved long-term patency in CVD management.
• Covered stents represent a promising advancement for recalcitrant cases.
• A multimodal approach considering both endovascular and surgical options is warranted for optimal CVD treatment.