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Updated: May 8, 2025
Murine Model of Central Venous Stenosis using Aortocaval Fistula with an Outflow Stenosis
Published on: July 11, 2019
Endovascular intravascular intervention for central venous stenosis in maintenance hemodialysis patients: a
Yiming Tao1, Jianyun Wang2, Jianchao Ma1
1Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Insights
Percutaneous transluminal angioplasty (PTA) and sequential percutaneous transluminal stenting (PTS) effectively treat central vein stenosis (CVS) in hemodialysis patients. PTA is suitable for <50% retraction, while PTS is for ≥50% retraction, ensuring improved vascular access.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Central vein stenosis (CVS) is a growing complication for patients on maintenance hemodialysis worldwide.
- It is particularly prevalent in patients with a history of catheterization or pacemaker implantation.
- CVS can significantly impair vascular access for hemodialysis.
Purpose of the Study:
- To investigate the characteristics of central vein stenosis (CVS) in hemodialysis patients.
- To evaluate the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone versus sequential percutaneous transluminal stenting (PTS) for treating CVS.
- To establish treatment guidelines based on the degree of venous elastic retraction.
Main Methods:
- Retrospective analysis of 26 hemodialysis patients with symptomatic CVS who underwent endovascular intervention.
- Procedures included PTA alone or sequential PTS.
- Patient characteristics, CVS features, and procedural outcomes were evaluated.
Main Results:
- Brachiocephalic vein stenosis was more common than subclavian vein stenosis (46.16% vs. 26.92%).
- Sequential PTS was used for more severe stenosis (≥50% retraction) compared to PTA alone (<50% retraction).
- Primary patency rates at 12 months were 71.43% for PTA alone and 66.67% for sequential PTS, with higher rates for stenting in complete occlusions (71.43%).
Conclusions:
- PTA alone is recommended for CVS with less than 50% central venous elastic retraction.
- Sequential PTS is recommended for CVS with 50% or greater central venous elastic retraction.
- Both PTA and PTS are safe and effective endovascular treatments for central vein stenosis in hemodialysis patients.
Background:
The number of people undergoing maintenance hemodialysis is increasing rapidly worldwide. Central vein stenosis (CVS) is a common vascular complication in undergoing hemodialysis, especially those with a history of catheterization. This study aimed to investigate the characteristics of CVS and the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone and sequential percutaneous transluminal stenting (PTS) in hemodialysis patients with CVS.
Methods:
A retrospective analysis of 26 cases of endovascular intervention for CVS using PTA alone or sequential PTS was performed. The characteristics of CVS and the clinical effectiveness of these procedures were evaluated.
Results:
This study included 26 hemodialysis patients who presented with symptomatic CVS. Of these 26 patients, 53.85% were male, and their mean age was approximately 54.96 years. All the patients had a history of catheter placement or pacemaker implantation. The incidence of brachiocephalic vein stenosis was significantly higher than that of subclavian vein stenosis (46.16% vs. 26.92%). Based on the degree of stenosis and elastic retraction, these patients were administered PTA alone or sequential PTS. There was no difference in patient age, hemodialysis time, catheter retention time, or stenosis length between the PTA alone and sequential PTS groups. However, the degree of venous stenosis in the PTS group was more severe than that in the PTA alone group. The primary patency rates in the sequential PTS and PTA alone groups were 94.12% and 100% at 3 months; 88.24% and 88.89% at 6 months; 75.00% and 85.71% at 9 months; and 66.67% and 71.43% at 12 months, respectively. It is worth noting that for 7 patients with complete occlusion of the brachiocephalic vein, we used sharp recanalization technology and stenting placement, with patency rates of 85.71% and 71.43% at 6 and 12 months, respectively.
Conclusions:
PTA alone is recommended for patients with less than 50% central venous elastic retraction, while sequential PTS is recommended for patients with ≥ 50% central venous elastic retraction. PTA and PTS are safe and effective methods for the treatment of CVS in patients undergoing hemodialysis.
