Endovascular treatment of iatrogenic central vein stenosis and occlusion in patients undergoing haemodialysis – a two-year follow-up

Objectives: The objective of our report was to present the results of two-year follow-up of endovascular treatment of central venous occlusive disease in haemodialysis patients.

Material and methods: Eighty-one consecutive patients with central venous occlusive disease, were included into the study group. There were 81 lesions treated (42 stenosis and 39 occlusions). Percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty with stenting (PTS) was committed. There was no randomisation. Stent implantation was avoided in vessels with a foreign body inside (catheter or electrode). Diagnostic phlebographies were performed after 12 and 24 months or if symptoms recurred. The follow-up period lasted for 24 months. There were 26 (70%) patients with primary stenosis and 11 (29%) with occlusion in the group with PTA therapy and 13 (38%) and 21 (61%) in the group with PTS therapy. Procedure was successful in all cases of stenosis, unsuccessful in 10 cases of occlusions. Seventeen patients died during first year of observation, 9 during the second. Two patients were lost to follow up. No serious adverse events were observed.

Results: Primary patency (PP) after 12 and 24 months was 50% and 26% after PTS, 33% and 21% after PTA respectively. Primary assisted patency (PAP) was 70% and 52% in PTS group while 86% and 92% in PTA group. Secondary patency (SP) 70% and 52% after PTS to 93% and 92% after PTA.

Conclusions: Both methods are safe and mildly effective in the treatment of central veins in haemodialysis patients. Both techniques should be applicable in specific clinical settings according to patient status and operator experience.