Central vein stenosis- prevalence, clinical characteristics, outcome and its impact on dialysis access

Central vein stenosis (CVS) is a complication primarily affecting chronic hemodialysis patients, frequently resulting in vascular access dysfunction and decreased dialysis efficacy. While CVS has a variable mortality rate, its impact on dialysis access is profound, including arm edema, facial swelling, and venous hypertension. We describe the prevalence, clinical presentation, and treatment outcomes of CVS for vascular access in hemodialysis patients. We conducted a prospective observational study from July 2023 to June 2024, on patients undergoing maintenance hemodialysis (MHD) at a tertiary care center in South India who had CVS detected by CT Venography. Demographic information, comorbidity, access type, stenosis location, clinical presentation, treatment, and outcome data were collected and analyzed. Of the 152 patients on MHD, 20 (13.1%) had CVS. Of them, 7 patients were on tunneled catheter and 13 were on AVF. Arm edema (47%) was the most common symptom, followed by face swelling (29%) and prolonged bleeding (11%) from arteriovenous fistula post dialysis. The brachiocephalic vein (BCV) was the most common site of stenosis in 65% of patients. Angioplasty was performed in (N = 9) nine patients with a primary success rate of 66% and a six-month patency of 44.4%. In the remaining eleven (N = 11) four patients (20%) transitioned to CAPD, three (15%) had new access of which two had femoral catheter inserted and other one had new AVF creation done and two (10%) continued dialysis via same access. Mortality occurred in two patients (10%) due to pulmonary edema. The Prevalence of CVS in our study population was 13.1%. Six-month primary patency rate among those who underwent intervention was 44.4%. Vascular access had to be terminated in 55%.