Balloon angioplasty with selective stenting strategy in treatment of hemodialysis related central vein occlusive lesions.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of balloon angioplasty and selective stenting in treatment of symptomatic central vein occlusive lesions (CVOL) in patients with upper extremity hemodialysis access.

METHODS: Seventy-four hemodialysis patients with symptomatic CVOL underwent endovascular therapy between March 2014 and November 2015. Both the primary and secondary patency rates were analyzed by the Kaplan-Meier plot method.

RESULTS: Forty males and thirty-four females manifesting with arm venous hypertension symptoms were enrolled. The mean age of patients was 49.7 years. Venography showed 29 complete occlusions (39.1%), and 45 stenotic lesions (60.9%). Percutaneous transluminal angioplasty (PTA) alone was performed in 46 cases and bare metal stenting was performed in 17 cases. The primary patency rates were (87±4.9)%, (67.4±6.9)%, and (51.7±7.4)% in the PTA group, and (94.1±5.7)%, (82.4±9.2)%, and (70.6±11.1)% in the stenting group at 3 months, 6 months, and 1 year, respectively. The secondary patency rate was (67.2±6.9)% in the PTA group, and (82.4±9.3)% in the stenting group at 1 year.

CONCLUSIONS: Balloon angioplasty with selective stenting is safe and effective treatment modality for CVOL in short term. Enhanced follow-up, and repeated interventions are required to maintain patency.