Treatment of hemodialysis related-central venous stenosis: 1-year results of venoplasty and follow-up in 50 patients

Purpose To analyze and evaluate the patency of the endovascular intervention for venous hypertension in upper-extremity hemodialysis access. Patients and methods A prospective cohort study of consecutive patients with chronic renal failure having symptomatic central venous stenotic lesions with hemodialysis access referred for endovascular treatment was conducted from May 2015 to May 2016. Procedure consisted of percutaneous angioplasty with or without stenting. Results A total of 50 patients (30 females and 20 males, with mean age of 47.7 years and range of 22-72 years) were included, and all had successful arteriovenous fistula (AVF) creation (native in 76% of patients and synthetic in 24% of patients). Overall, 64% of the patients had left-sided AVF, and the remaining 36% had right-sided AVF. Patency rates of 34 patients collectively were 100, 97, and 70% at 3, 6, and 12 months, respectively. One-year patency rate of cases with single-lesion group was 91.6%, and those with multiple lesions was 8.3%, with statistically significant difference between the two groups. However, the term patency rate for patients with short lesions (<3 cm) was 66.6% and for those with lesions more than 3 cm was 33.3%. This was statistically insignificant, with P value equal to 0.1. Conclusion Percutaneous central venous angioplasty could provide satisfactory symptomatic relief in patients who presented with central venous stenosis together with upper-extremity edema. Endovascular procedure offers a minimally invasive, first option of management for a difficult problem in a patient population with significant comorbidities and infrequent complications. However, the durability of percutaneous transluminal angioplasty is limited, and in most patients, adjunctive interventions were required to extend the symptom-free period.