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Percutaneous recanalization of occlusion of central and proximal veins in chronic hemodialysis. Technical note
P Morinière1, R Rodary-Vautier, V Fillioux-Morfaux
1Nephrology, Haemodialysis Unit, Amiens University Hospital, France.
Insights
Percutaneous recanalization with angioplasty successfully restored central vein patency in hemodialysis patients, preserving vital vascular access. This minimally invasive technique avoids the need to close the access, preventing significant arm edema.
Area of Science:
- Interventional Radiology
- Nephrology
- Vascular Surgery
Background:
- Central vein occlusion in chronic hemodialysis patients causes severe arm edema and necessitates closure of the vascular access.
- Loss of vascular access, often the last available option, presents a significant challenge for patient management.
Purpose of the Study:
- To evaluate the efficacy of percutaneous recanalization followed by endoluminal angioplasty for treating occluded central veins in hemodialysis patients.
- To determine if this technique can preserve the vascular access and avoid surgical intervention.
Main Methods:
- Percutaneous recanalization and endoluminal angioplasty were performed on occluded central veins (innominate and axillary) in hemodialysis patients.
- Stent placement was not systematically used in all cases.
Main Results:
- Successful recanalization and maintained patency were achieved in 4 out of 6 patients, with patency lasting up to 26 months.
- One patient experienced immediate failure, and another had delayed failure after two months without systematic stent placement.
- The procedure successfully preserved vascular access in the majority of treated patients.
Conclusions:
- Percutaneous recanalization by angioplasty is an encouraging technique for treating occluded central veins in hemodialysis patients.
- Successful intervention preserves the vascular access, avoiding the need for complex surgery and managing arm edema.
- This minimally invasive approach should gain wider recognition and application.
Abstract:
Occlusion of the central and proximal veins in chronic hemodialysis patients results in considerable edema of the arm of the vascular access that is unable to drain normally. This is a formidable problem because it is very often necessary to close the vascular access, which is sometimes the last available one. To avoid resorting to this disastrous solution, recanalization of the occluded vein by percutaneous recanalization followed by endoluminal angioplasty was successfully performed in five patients (4 innominate veins and one axillary vein). Immediate failure occurred in a sixth patient, and delayed failure after two months of patency (innominate vein) in another patient for whom there had been no systematic stent placement. Recanalization was still patent in four other patients at 3, 6, 12 and 26 months. These results are an encouragement to attempt percutaneous recanalization by angioplasty of occluded central veins because, when successful, this technique makes it possible to preserve the vascular access and to avoid onerous surgery. We believe that this technique should therefore become better known.