The feasibility and safety of a through-and-through wire technique for central venous occlusion in dialysis patients
Purpose: To report our experience and results with the endovascular treatment of central vein stenoses and occlusions in hemodialysis patients. Methods: Between October 1999 and August 2001 (22 months) we performed 22 interventional procedures in 14 hemodialysis patients (8 women, 6 men) ranging in age from 38 to 87 years (mean 76 years). The indication for intervention was stenosis (n = 10) or occlusion (n = 4) of a central vein in the upper arm used for dialysis in patients with arm swelling and/or shunt malfunction. All patients had a previous history of subclavian vein cannulation. There were six percutaneous transluminal angioplasties (PTAs) and eight primary stent placements and eight repeat interventions. Seven were for restenoses and one for early occlusion, with two secondary stent placements and six PTA of in-stent stenoses. In two patients a second stent was implanted. The mean follow-up was 8.5 months (range 1–19 months). All stents were self-expandable with diameters ranging from 9 to 16 mm. Results: All but one of the procedures was technically successful (95%, n = 21). The patient with an unsuccessful procedure died 1 month after the procedure, but the death was not procedure-related. During follow-up three patients died with a patent shunt and central vein, none of them in connection with the procedure. No complication occurred during the interventional procedures. One patient was lost to follow-up. The primary patency rate at 12 months was 43%, with a primary assisted patency rate of 83% and a secondary patency rate of 100% (n = 6). Conclusion: Central vein stenoses and occlusions are associated with previous subclavian vein cannulation. They are a serious problem in hemodialysis patients with a shunt on the same arm. Endovascular treatment is a suitable option for these patients.