Stent implantation for the treatment of central venous obstruction in hemodialysis patients with arteriovenous fistula: analysis of its clinical value / 介入放射学杂志

ABSTRACT

Objective To discuss the feasibility and clinical value of percutaneous transluminal stenting (PTS) for the treatment of central venous obstruction (CVO) in hemodialysis patients with arteriovenous fistula (AVF).Methods The clinical data of 10 hemodialysis patients with AVF complicated by CVO were retrospectively analyzed.Clinically,all patients presented as swollen hand syndrome.Preoperative or intraoperative digital subtraction angiography (DSA) was performed to determine the obstruction site,and based on the disease condition the appropriate surgical approach was employed.For patients having thrombus formation,catheter-directed thrombolysis (CDT) was carried out first.For patients having severe stenosis or occlusion of veins,pre-expansion with small diameter balloon was employed before PTS.For the remaining patients,PTS was directly performed.All patients were regularly followed up after operation.Results DSA showed that brachiocephalic vein occlusion and/or occlusion or stenosis of subclavian vein,internal jugular vein and superior vena cava were observed in 5 patients who had history of internal jugular vein catheterization,while localized severe stenosis of medial segment of AVF-side subclavian vein was detected in the other 5 patients who had no history of internal jugular vein catheterization.The technical success rate of PTS was 100％ (10/10).A total of 19 stents were implanted in the 10 patients.Seven months after the treatment,one patient developed in-stent re-stenosis,and PTS had to be carried out again.Primary patcncy rates at 6 months and 12 months after the treatment were 100％ (8/8) and 75％ (3/4) respectively.Conclusion In hemodialysis patients with AVF,CVO is mainly characterized by obstructive or severely stenotic lesions.PTS carries higher success rate with satisfactory short-term and mid-term effect,its complications are slight and mild,and the technique is safe and feasible.Therefore,PTS can be used as the preferred treatment method.