Covered Venous Stenting For Recalcitrant Central Vein Stenosis In Hemodialysis Patients: Short And Mid-term Outcomes.
Amarseen Mikael, MD1, Ashtin Jeney, MD2, Raja Gnanadev, MD2, Ann Yufa, MD3, Iden Andacheh, MD4.
1UC Riverside SOM/RIverside Community Hospital, Riverside, CA, USA, 2Arrowhead Regional Medical Center, Colton, CA, USA, 3Einstein Health, Philadelphia, PA, USA, 4Kaiser Fontana, Fontana, CA, USA.
OBJECTIVES: Central venous stenosis (CVS) is a potential cause of prolonged bleeding, aneurysmal degeneration, and thrombosis in patients with arteriovenous fistulas (AVF) or grafts (AVG). CVS has traditionally been managed with venoplasty; however, over half of patients will develop recurrent CVS. While prior studies have looked at short-term results, data is lacking with respect to mid-term clinical outcomes of covered endovenous stenting (CES) in treating recalcitrant CVS in symptomatic hemodialysis patients.
METHODS: A retrospective examination was performed across two different institutions from 2016 to 2020. Ten patients underwent CES for recurrent CVS following prior venoplasty. Indications for intervention included: aneurysmal degeneration, increased bleeding after dialysis, and fistula thrombosis. The average follow-up time in this study was 2.6 years. All stents used were GORE (Flagstaff, Az) Viabahn stents. Prospective follow-up was performed on these patients, and the primary data endpoint was ipsilateral dialysis access primary patency. Secondary data points included venous stent patency.
RESULTS: Out of ten patients (four occlusion, six stenosis), one was lost to follow up. Technical success rate was 100% at crossing stenotic or occluded central venous segments. There were no major complications attributable to the CES procedure. An average of one stent was deployed per patient; average stent diameter was 10 mm and length was 3.9 cm. The observed primary patency rate of ipsilateral AV access was 100% at one year, 83% at two years, and 66% at years three and four. The secondary endpoint of central vein stent primary patency was 100% at one year and 88.8% at two years.
CONCLUSIONS: CVS can result in potential loss of hemodialysis access. Our data suggests that CES results in excellent short-term and mid-term patency and preservation of ipsilateral hemodialysis access. CES should be considered as a means of treating venoplasty-recalcitrant CVS in hemodialysis patients. No previous study has evaluated mid-term outcomes in this patient population. Further studies are warranted to evaluate the long-term effectiveness of covered stents for recurrent CVS.
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