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Cavoatrial junction stenting in vascular hemodialysis catheter malfunction

Federico Francisco Pennetta1, Massimiliano Millarelli2, Francesco De Santis2

  • 1Vascular and Endovascular Surgery Unit, University of Rome, Tor Vergata, Rome, Lazio, Italy.

The Journal of Vascular Access
|May 6, 2024
PubMed

Insights

Cavoatrial junction stenosis, a complication of hemodialysis catheters, can be safely treated with stenting. This procedure effectively resolves stenosis, preserving central vein patency for long-term vascular access.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Nephrology

Background:

  • Central vein stenosis or occlusion is a frequent complication in patients requiring hemodialysis via intravascular catheters.
  • Superior Vena Cava Syndrome (SVCS) is well-characterized, but data on Cavoatrial Junction (CAJ) stenosis is lacking.
  • Catheter failure due to thrombosis or infection can necessitate novel vascular access solutions.

Purpose of the Study:

  • To report the feasibility and safety of stenting Cavoatrial Junction (CAJ) stenosis in hemodialysis patients.
  • To evaluate the long-term outcomes of CAJ stenting in patients with multiple previous catheter failures.
  • To highlight the importance of maintaining patency of the CAJ and upper veins for hemodialysis access.

Main Methods:

  • Computed tomography (CT) and venography were used to diagnose CAJ stenosis.
  • Two patients with recurrent catheter failures underwent stenting of the CAJ stenosis.
  • A Gore Viabahn VBX balloon-expandable endoprosthesis was used for stenting the CAJ.

Main Results:

  • Radiological signs of CAJ stenosis were confirmed by venography.
  • Successful stenting of the CAJ resulted in complete resolution of stenosis in both patients.
  • No procedural complications were observed.
  • Mean follow-up of 878 ± 559 days showed no signs of in-stent restenosis or recoil.

Conclusions:

  • Stenting of the Cavoatrial Junction (CAJ) is a feasible and safe treatment option for stenosis in hemodialysis patients.
  • This intervention can restore patency and potentially prolong the usability of vascular access.
  • Preserving CAJ and upper vein patency is crucial for effective hemodialysis access management.

Keywords:
Hemodialysislarge upper vein stenosisstentingsuperior vena cava syndromevascular access

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