Percutaneous transluminal angioplasty (PTA) and venous stenting in hemodialysis patients with vascular access-related venous stenosis or occlusion

Aim of the studyTo present our experience with PTA and venous stenting in hemodialysis patients with vascular access (VA) related venous stenosis or occlusion.Patients – methodsWe studied retrospectively 22 hemodialysis patients with VA-related venous stenosis or occlusions that were treated with PTA and subsequent stenting. The following lesions were detected by digital subtraction venography: occlusion of the brachiocephalic and/or subclavian veins in four patients, stenosis (80–90%) of the same veins in 10 patients, stenosis (80–95%) of the axillary vein in four patients, brachial vein stenosis in two patients, and cephalic vein stenosis in two patients. The follow-up period ranged from 3 to 29 months (mean 15.4 ± 9.8 months). Primary and cumulative stent patency was recorded.ResultsTwenty-two primary venous PTA–stent implantation procedures were performed using 25 stents. The initial deployment of these 25 stents was technically successful, with complete opening (>80%) of the vein's lumen in all but one patient (95.4%). The patency of the vein immediately after the stenting procedure was greater than 90% in 13 patients, 80–90% in eight patients, and less than 40% in the case involving failure. Seventeen episodes of re-obstruction occurred in 13 patients (59%), and all were treated with the same PTA–stent procedures. At the end of the study period 47 stents had been placed in patients. The 3, 6, 12 and 24-month primary patency rates were 88.3%, 65.3%, 45.6% and 25.5%, respectively. Overall cumulative stent patency was 95.4% after 3 months, 79% after 6 months, 74% after 12 months, and 62.8% after 24 months.ConclusionPTA with primary venous stenting is an effective method for the treatment of VA-related stenosis or occlusion. However, repeat and sometimes multiple interventions are usually needed for the treatment of re-stenosis or re-occlusion episodes.