Percutaneous Angioplasty and Stenting in Chronic Hemodialysis Patients with Central Venous Stenosis

Yang, Jong Oh; Lee, Sang Ju; Park, Ki Hyun; Jang, Yun Kyung; Kang, Min Kyu; Sung, In Whan; Lee, Kang Wook; Shin, Young Tai

Abstract

Stenosis of the subclavian vein after cannulation occurs in 15-50% of chronic hemodialysis patients, and impedes the placement of an arteriovenous fistula in the ipsilateral arm. Its natural history and pathogenic mechanism are not well established yet. To investigate the clinical characteristics of the patients and therapeutic effect of percutaneous angioplasty and stenting, 10 consecutive chronic hemodialysis patients(3 men and 7 women; mean 55 year old) from March 1999 to February 2001 who showed subclavian vein stenosis and were treated with above percutaneous procedure were included in this study. The patients were followed for median 15.8(9.3-23.7) months after stenting. The causes of chronic renal failure were hypertension in four, diabetes mellitus in four, and unknown in two patients. Edema was noted on left upper extremity in nine and right in one patient. All cases of stenosis of central vein were found in ipsilateral side. Duration from beginning of hemodialysis to angioplasty and stenting was median 28(0.5-180) months. Duration for keeping subclavian vein catheter was median 35(13-65) days and duration for arteriovenous fistula in ipsilateral arm was median 15.1(1.1-120) months before stenting. All patients were performed stenting successfully and edema of upper extremities began to decreased immediately after the procedure. Involved stenosis lesions were noted on left bracheocephalic vein in seven, left subclavian vein in two, and right bracheocephalic vein in one patient. Restenosis after the procedure occurred in three patients in 1 year after stenting, and percutaneous balloon angioplasty(198, 256, 276 days after initial stenting) was performed again successfully. There was no severe complication during the procedure in all patients. In conclusion, we speculate that percutaneous angioplasty and stenting is a safe and effective therapeutic modality in chronic hemodialysis patients with central vein stenosis.