Central Vein Stenosis in Hemodialysis Patients

Seo, Young Min; Koo, Ja Hyun; Kim, Hyung Tae; Cho, Won Hyun

Abstract

PURPOSE
Central vein stenosis (CVS) is a common problem for the patients on chronic hemodialysis. It is primarily a result of previous catheterization of a central vein. This study investigated the characteristics of this problem and the effect following treatment different modalities. METHOD: We reviewed the medical records of 23 dialysis patients who had diagnosed with central venous stenosis from January 2001 to March 2005. We reviewed the characteristics, clinical manifestations and effects of treatment. RESULT: Of the total 23 patients, 9 patients had no past history of central vein catheterization ipsilateral to the vascular access. The most common site of venous lesion was the left innominate vein (n=12). A total of 20 patients underwent treatment. Of these 20 patients, 14 (20%) underwent balloon angioplasty, 5 underwent percutaneous transluminal angioplasty (PTA) with stent insertion and 1 underwent bypass surgery. The primary patency rate was 57% for the balloon angioplasty and 40% for the PTA with stent insertion. The numbers of patients in need of repeat treatment following the initial endovascular treatment were 2 of 14 patients (14%) for balloon angioplasty and 2 of 5 (40%) for the PTA with stenting.
CONCLUSION
The primary goal of diagnosis and therapy for CVS is to maintaining the functionality of the access and to relieve the symptoms. Radiogical intervention is a gold standard. The long term patency after angioplasty, with or without stents, remains unproven.