Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

Abstract 

Aim of the study

To present our experience with PTA and venous stenting in hemodialysis patients with vascular access (VA) related venous stenosis or occlusion.

Patients – methods

We studied retrospectively 22 hemodialysis patients with VA-related venous stenosis or occlusions that were treated with PTA and subsequent stenting. The following lesions were detected by digital subtraction venography: occlusion of the brachiocephalic and/or subclavian veins in four patients, stenosis (80–90%) of the same veins in 10 patients, stenosis (80–95%) of the axillary vein in four patients, brachial vein stenosis in two patients, and cephalic vein stenosis in two patients. The follow-up period ranged from 3 to 29 months (mean 15.4±9.8 months). Primary and cumulative stent patency was recorded.

Results

Twenty-two primary venous PTA–stent implantation procedures were performed using 25 stents. The initial deployment of these 25 stents was technically successful, with complete opening (>80%) of the vein's lumen in all but one patient (95.4%). The patency of the vein immediately after the stenting procedure was greater than 90% in 13 patients, 80–90% in eight patients, and less than 40% in the case involving failure. Seventeen episodes of re-obstruction occurred in 13 patients (59%), and all were treated with the same PTA–stent procedures. At the end of the study period 47 stents had been placed in patients. The 3, 6, 12 and 24-month primary patency rates were 88.3%, 65.3%, 45.6% and 25.5%, respectively. Overall cumulative stent patency was 95.4% after 3 months, 79% after 6 months, 74% after 12 months, and 62.8% after 24 months.

Conclusion

PTA with primary venous stenting is an effective method for the treatment of VA-related stenosis or occlusion. However, repeat and sometimes multiple interventions are usually needed for the treatment of re-stenosis or re-occlusion episodes.

Keywords: PTA, Stent, Hemodialysis, Venous stenosis