Central venous obstructions in hemodialysis patients: Surgical and endovascular treatment - A review [Zentralvenöse obstruktionen beim dialysepatienten: Chirurgische und endovaskuläre behandlung - Eine übersicht]

The main cause of central venous obstruction in hemodialysis patients is prolonged or repeated catheterization for dialysis access. The most frequent complaints are disabling swelling and pain, sometimes combined with venous ulceration. Access ligation brings immediate relief but makes the creation of another permanent access necessary. For the multimorbid hemodialysis patient, interventional treatment of the obstruction means a minimally invasive option to preserve the access with tolerable long-term results. The role of stent implantation (during every intervention or for selected indications) is still controversial. Surgical reconstruction of central veins probably provides better patency rates, but is associated with significant morbidity and mortality. When interventional treatment fails, implantation of an extra-anatomical veno-venous bypass should be considered rather than anatomical reconstruction. Arterio-arterial loop grafts can be used as a last resort access in case of combined superior and inferior vena cava obstruction. © 2007 Springer Medizin Verlag.