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Undersized Versus Conventional Covered Stent Sizing for Hemodialysis Access-Related Central Venous Occlusive Disease:

John Chien-Hwa Chang1,2, Shih-Ming Huang1,2, Honda Hsu3,2

  • 1Division of Cardiovascular Surgery.

Acta Cardiologica Sinica
|January 29, 2026
PubMed

Insights

Undersized covered stents demonstrated superior 12-month access patency compared to apposed/oversized stents in hemodialysis patients with central venous occlusive disease. This suggests a potential benefit for undersized stent placement in managing this condition.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Central venous occlusive disease (CVOD) is a complication in patients requiring hemodialysis access.
  • Endovascular treatment is a common approach for managing CVOD.

Purpose of the Study:

  • To compare access and target lesion patency rates between undersized and apposed/oversized lateral-edge covered stents in hemodialysis patients with CVOD.

Main Methods:

  • Retrospective analysis of 76 hemodialysis patients with CVOD treated with endovascular covered stents.
  • Patients were categorized into undersized (n=14) and apposed/oversized (n=62) lateral-edge stent groups.
  • Patency outcomes were assessed using log-rank tests and multivariable analysis.

Main Results:

  • The 12-month access primary patency rate was significantly higher in the undersized group (76.4%) compared to the apposed/oversized group (25.9%, p=0.047).
  • While the 12-month target lesion primary patency rate was also higher in the undersized group, the difference was not statistically significant (76.4% vs. 52.1%, p=0.186).
  • Older age, coronary artery disease, stenting for access thrombosis, increased stent number, apposed/oversized lateral stent edge, and higher stent-to-vessel ratio were associated with poorer outcomes.

Conclusions:

  • Undersized covered stents showed improved 12-month primary patency rates for hemodialysis access-related CVOD compared to apposed/oversized stents.
  • Endovascular treatment utilizing undersized covered stents appears to be a feasible strategy for CVOD.
  • Larger randomized controlled trials are necessary to validate these findings.
Abstract

Keywords:
Central venous occlusive diseases (CVODs)Covered stentHemodialysisUndersized

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