Endovascular treatment of central vein occlusion in patients with functioning arteriovenous fistulas

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Nephrology

Background:

• Growing dialysis patient populations and organ transplant shortages increase reliance on central venous access for hemodialysis.
• Prolonged use of central venous catheters is the primary cause of central vein stenosis due to intimal injury.
• Central vein stenosis/occlusion significantly impacts hemodialysis access and patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of angioplasty in treating central vein occlusion among patients with established arteriovenous fistulas.
• To assess the clinical outcomes and patency rates following endovascular intervention for central vein lesions.

Main Methods:

• Retrospective cohort study involving 47 patients with central vein stenotic or occlusive lesions.
• Interventions included transluminal percutaneous angioplasty (TPA) alone or with stenting.
• Patient outcomes were assessed at 30 days, 6 months, and 1 year post-procedure.

Main Results:

• Stenotic lesions were identified in 53% of patients, and occlusions in 47%.
• TPA with stenting was performed in 64% of cases; balloon angioplasty alone in 36%.
• Early clinical improvement (30 days) was observed in 82% of patients. At 1 year, primary patency was 57% and assisted primary patency was 72%.

Conclusions:

• Endovascular treatment, including TPA and stenting, provides significant clinical improvement for central vein stenosis or occlusion.
• The procedure demonstrates acceptable 1-year patency rates, offering a viable solution for hemodialysis access complications.
• Further research with larger sample sizes is warranted to confirm these findings.