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Treatment of Hemodialysis-related Central Venous Stenosis or Occlusion: Results of Primary Wallstent Placement and Follow-up in 50 Patients¹

¹ From the Department of Diagnostic Radiology, University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany (P.H., W.P., K.S., R.W.G.) and the Department of Diagnostic and Interventional Radiology, Klinikum Ingolstadt, Germany (D.V.). From the 1998 RSNA scientific assembly. Received July 10, 1998; revision requested August 28; revision received October 2; accepted January 19, 1999. Address reprint requests to P.H. (e-mail: haage@rad.rwth-aachen.de).

PURPOSE: To analyze the effectiveness of stent placement as the primary treatment for central venous obstruction in patients undergoing hemodialysis.

MATERIAL AND METHODS: Fifty-seven Wallstents were placed in 50 patients with symptomatic shunt dysfunction and arm swelling due to central venous obstruction. Technical success, complication, and patency rates were evaluated.

RESULTS: Stent deployment was successful in all patients, and early rethrombosis (within 1 week) was noted in one patient (2%). Seventy-three episodes of reobstruction occurred and were treated percutaneously with angioplasty alone in 54 cases (74%). Nineteen cases (26%) necessitated additional stent placement. The 3-, 6-, 12-, and 24-month primary patency rates were 92%, 84%, 56%, and 28%, respectively. Cumulative overall stent patency was 97% after 6 and 12 months, 89% after 24 months, and 81% after 36 and 48 months.

CONCLUSION: In the treatment of brachiocephalic and subclavian venous obstruction, stent placement shows excellent technical results and helps preserve vascular access for a substantial period. Multiple repeat interventions are, however, frequently required to maintain patency.

Index terms: Dialysis, shunts • Veins, grafts and prostheses, 9461.1286, 9462.1286 • Veins, innominate, 9461.752 • Veins, stenosis or obstruction, 9461.454, 9462.454 • Veins, subclavian, 9462.752 • Veins, thrombosis, 9461.752, 9462.752 • Veins, transluminal angioplasty, 9461.1286, 9462.1286

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