Proximal Vein Obstruction or Stenosis Failed to Angioplasty in Hemodialysis Patients: Treatment with Endovascular Stent

Kim, Young Ok; Kim, Byung Soo; Yoon, Sun Ae; Song, Ha Hun; Kim, Ki Tae; Ko, Gi Young; Shin, Mi Jung; Park, Joo Hyun; Yang, Chul Woo; Kim, Yong Soo; Bang, Byung Kee

Abstract

Although percutaneous angioplasty is effectively used in the treatment of vascular access stenosis in hemodialysis patients, it has low initial success rate and high recurrence rate for proximal vein obstruction or stenosis. We evaluated the effect of endovascular stent placement on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients. Wallstent was placed in 8 hemodialysis patients with vascular access obstruction or stenosis. All lesions were proximal to a functioning access which had been created one month to 4 years prior to onset of symptoms. Of the total patients, 4 patients had central vein stenosis(2 subclavian, 2 innominate vein stenosis) and they all had a history of subclavian vein catheterization for hemodialysis. Seven patients presented with arm edema, one suffered from needling difficulty. Venography showed complete obstruction in 4 patients and severe stenosis in 4 patients. Angioplasty was attempted before stent placement but failed in all patients. The stent placement initially succeeded in all patients. There were no acute complications such as stent displacement, sepsis, and bleeding. After this intervention, clinical symptoms disappeared and all patients could be immediately treated with hemodialysis via corrected access. The patients were followed for 8.0+/-4.6 months (3-16 months). During this period, restenosis occurred in 2 patients. Of the 2 patients, one patient was successfully treated with angioplasty. In conclusion, endovascular stent placement seems to be effective on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients.