Treatment of an Unyielding Central Vein Stenosis using Valvuloplasty Balloon in a Young Female Presenting with Ineffective Hemodialysis

Abstract Percutaneous balloon venoplasty is widely employed for the management of central vein stenosis (CVS), a condition frequently encountered in patients on maintenance hemodialysis (MHD). The hypertrophied and fibrotic venous stenotic lesions often pose a challenge for interventionists, due to resistance to dilatation and high-elastic recoil. We report here successful utilization of mitral valvuloplasty balloon for percutaneous treatment of an unyielding brachiocephalic vein stenosis. Repeated failure of conventionally used peripheral balloon dilatation catheter prompted the use of a mitral valvuloplasty balloon that could exert higher radial pressure while preventing melon-seeding and hence successfully achieve stenosis dilatation. The mitral valvuloplasty balloon can be effectively and safely used for lesions resistant to repeated dilatations by conventional peripheral balloons. Rheological stress on central veins from ipsilateral arteriovenous fistula (AVF) may result in development of stenotic lesions, even in the absence of prior venous catheterization of the affected vein; therefore, in the presence of relevant symptoms, this diagnosis should not be excluded on the basis of absence of prior direct trauma at the stenosis site.