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Correction of central venous stenoses: use of angioplasty and vascular Wallstents
E C Kovalik1, G E Newman, P Suhocki
1Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Insights
Vascular stents are best for central venous stenoses with elastic recoil after angioplasty. Angioplasty alone has high restenosis rates, especially for elastic lesions, making stents a better option for these cases.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Central venous stenoses are common in hemodialysis patients, causing complications like fistula thrombosis and limited vascular access.
- These stenoses often respond well initially to angioplasty but tend to recur rapidly.
- Lesion response to angioplasty helps classify them as elastic or nonelastic, influencing treatment outcomes.
Purpose of the Study:
- To compare the effectiveness of angioplasty alone versus angioplasty with Wallstent placement for central venous stenoses.
- To evaluate the long-term success rates and recurrence patterns for different types of stenoses treated with these methods.
Main Methods:
- A comparative study involving 30 patients treated with angioplasty alone and 11 patients treated with angioplasty and Wallstent placement for central venous stenoses.
- Classification of stenoses into elastic and nonelastic types based on response to angioplasty.
- Assessment of immediate success, restenosis rates, and symptom recurrence over time.
Main Results:
- Angioplasty alone resulted in >50% luminal improvement in 70% of patients, but 81% restenosed within an average of 7.6 months. Elastic lesions treated with angioplasty alone occluded in 100% within 2.9 months.
- For recurrent stenoses treated with angioplasty and Wallstent, 80% of nonelastic lesions recurred within 4.2 months, and 4 of 5 elastic lesions recurred within 8.6 months.
- Angioplasty alone showed poor long-term patency, particularly for elastic lesions.
Conclusions:
- Vascular stents are recommended for central venous stenoses exhibiting elastic recoil after initial angioplasty.
- Angioplasty alone is less effective for managing elastic stenoses due to high rates of occlusion and recurrence.
- Stent placement may offer improved outcomes for specific types of complex or recurrent venous stenoses.
Abstract:
Central venous stenoses are a frequent complication in hemodialysis patients. These lesions lead to fistula thromboses, arm swelling, and limit future vascular access. Stenoses are characterized by excellent initial response to transluminal angioplasty but rapid recurrence. Response to angioplasty allows classification of stenoses as elastic or nonelastic. The success of angioplasty alone in 30 patients with central venous stenoses was compared to angioplasty and Wallstent placement in 11 patients with recurrent stenoses. In those who had angioplasty alone, 7%+ failed angioplasty, 70% had > or = 50% improvement in the luminal diameter while 23% showed no improvement due to elastic lesions. Subsequently, 81% of those with a successful result restenosed at an average of 7.6 months while 100% of elastic lesions occluded in an average of 2.9 months. In the 10 patients who underwent angioplasty and Wallstent placement, 5 were due to elastic lesions with four recurrences at a mean of 8.6 months. Four of five patients (80%) stented with nonelastic lesions had reappearance of symptoms at a mean of 4.2 months. We conclude that vascular stents should be reserved for those lesions that show elastic recoil after standard angioplasty.