Clinical outcomes of endovascular treatment in hemodialysis patients with central venous stenosis: A retrospective analysis.

Abstract

Introduction: Endovascular treatment is one of treatment options for hemodialysis patients with central venous stenosis (CVS), but clinical outcomes and risk factors remain inadequately studied. This study seeks to investigate the occurrence and risk factors associated with CVS.

Methods: This retrospective study analyzed the distribution and causes of 385 lesions in 309 hemodialysis patients with symptomatic CVS. We particularly examined patients with single-segment lesions treated with endovascular treatment to explore patency rates and related factors.

Results: The proportion of catheter-related superior vena cava (SVC) lesions was 100%. In the subgroup of single-segment lesions (from 205 patients) 187 patients successfully treated with endovascular treatment (technical success was 91.22%) and Cox analysis revealed that age over 50 years (HR = 2.057, 95% CI: 1.174-3.603, p = 0.012), upper-arm arteriovenous fistula (HR = 1.832, 95% CI: 1.127-2.977, p = 0.015), and presence of preoperative collateral circulation (HR = 1.924, 95% CI: 1.241-2.982, p = 0.003) were prognostic factors influencing the 1-year primary patency rate of subclavian veins, while age over 50 years (HR = 3.618, 95% CI: 1.465-8.933, p = 0.005), upper-arm arteriovenous fistula (HR = 1.972, 95% CI: 1.116-3.482, p = 0.019), high pressure to efface waist at the stenotic site (HR = 2.343, 95% CI: 1.106-4.961, p = 0.026), and diabetes (HR = 1.953, 95% CI: 1.042-3.661, p = 0.037) were prognostic factors for brachiocephalic veins. Due to the small sample size, comprehensive analysis of risk factors for restenosis could not be performed.

Conclusion: Central venous balloon angioplasty is an effective treatment for central venous stenosis in hemodialysis patients, with satisfactory technical and clinical success rates. Age, upper arm fistula and collateral circulation are important factors affecting the treatment outcome for subclavian veins. Similarly, the corresponding factors for the brachiocephalic veins include age, upper-arm fistula, high pressure to efface waist and diabetes.