Endovascular treatment in hemodialysis-related central venous obstruction: Angiographic findings, both before and after treatment, outcome and complications

Abstract

Problem/background : The incidence of patients with end-stage renal disease (ESRD) has been increasing and the complications related to hemodialysis vascular access is the cause of prolonged hospitalization. The most common complication after vascular access is venous thrombosis. There are two effectively interventional treatment procedures of central venous obstruction; (1) Percutaneous transluminal angioplasty (PTA) and (2) endovascular stent placement.

Objective : This research was performed to describe angiographic imaging of hemodialysis-related central venous obstruction, both before and after endovascular treatment and the outcomes and complications of endovascular treatment in patients with hemodialysis-related central venous obstruction.

Design : Descriptive study.

Setting : Department of Radiology, Faculty of Medicine, Chulalongkorn University.

Material and Methods : A retrospective review of 53 digital subtraction angiographic studies (DSA) was performed on 32 patients with hemodialysisrelated central venous obstruction at King Chulalongkorn Memorial Hospital from 2006 to 2010.

Result : Central venous obstruction can occur anywhere along the venous outflow tract. The PTA was performed in all cases and stent was deployed in 59% (19/31). Almost of the cases are technical successful after PTA and or stent placement in 96.8% (31/32). The only one patient was unsuccessful angioplasty due to difficult perform vascular access. The most lately outcome is re-stenosis in all cases. The overall primary patency of the endovascular treatment is in range of 2 months to 24 months.

Conclusion : PTA with or without stent placement appear to be the standard treatment of hemodialysis related central venous obstruction in ESRD in KCMH. Most of the patients received successfully interventional treatment without immediate complication. The most common lately outcome after PTA with or without stent treatment is re-stenosis in the obstructed site.