Stenting of central venous stenoses in hemodialysis patients: long-term results

From November 1992 through July 1996, 15 Wallstents were implanted for the treatment of symptomatic central arm vein obstructions in 14 hemodialysis patients (10 subclavian, 2 brachiocephalic vein stenoses, 2 subclavian vein occlusions). There were no acute complications. All patients were investigated by clinical examination and color-duplex sonography at regular three month intervals. When recurrent swelling predicted restenosis, phlebography was also performed. During the follow-up, high grade stenoses at the central or peripheral ends of four stents were successfully treated with five overlapping stents, giving a total of 20 Wallstent implantations. Complete occlusion of another subclavian vein distally to the stent at 16 months required ligation of the patient's arteriovenous fistula. Life table analysis including all 20 stents revealed a cumulative primary one year (two year) stent patency of 70% (50%). The cumulative secondary one year (two year) stent patency was 100% (85%). We believe that in hemodialysis patients, PTA plus Wallstent implantation is a safe and effective procedure in the treatment of central venous stenoses and even shorter occlusions. Consequent follow-up allows for timely diagnosis and treatment of restenoses, thus guaranteeing long-term patency rates comparable to those of veno-venous bypass surgery.