Central venous occlusion in hemodialysis access: comparison between percutaneous transluminal angioplasty alone and nitinol or stainless-steel stent placement

Abstract

Purpose: The purpose of this study was to compare the primary and secondary patency rates occlusion; of percutaneous transluminal angioplasty (PTA) atone with those of metallic stent placement Angioplasty; in patients with hemodialysis access and central venous occlusion (CVO) and to compare the Hemodiatysis; respective effects of nitinol and stainless-steel stents on patency. Materials and methods: A total of 150 consecutive patients with hemodialysis access who under-went endovascular treatment for symptomatic CVO with ipsilateral functioning hemodialysis access were evaluated. There were 67 men and 83 women with a mean age of 56.2 +/- 15.2 (SD) years (range: 15-86 years). The primary endovascular treatment of CVO was PTA alone. Stent placement either with nitinol or stainless-steel stents was performed as a bailout procedure. The results were analyzed on a per patient basis. Results: Technical success was achieved in 141/150 patients (94%). Of the 141 patients, 109 (77%) underwent PTA alone and 32 (23%) underwent stent placement. The mean number of interventions in the stent group [4.3 +/- 2.5 (SD)] was significantly higher than that in the PTA alone group [2.6 +/- 2.8 (SD)] (P=0.002). The primary patency rates at 12, 24, and 60 months for the stent group (58.7%, 41.9%, and 27.9%, respectively) were significantly higher than those in the PTA alone group (42.4%, 36.3%, and 20.2%, respectively) (P=0.036). Secondary patency rates at 12, 24, and 60 months for the stent group (87.6%, 80.7%, and 50.3%, respectively) were significantly greater than those in the PTA alone group (68.4%, 56%, and 38.6%, respectively) (P = 0.046). Furthermore, the primary patency rates at 6 and 12 months in the nitinol stent group (89% and 80.9%, respectively) were significantly greater than those in the stainless-steel stent group (78.8% and 38.4%, respectively) (P= 0.007). The secondary patency rates at 6, 12 and 24 months for the nitinol stent group (92.8%, 87.7% and 65.8%, respectively) were significantly greater than those in the stainless-steel stent group (85.7%, 76.2% and 65.3%, respectively) (P=0.011). Conclusion: Although PTA alone is an effective interventional treatment strategy of CVO in short term, stent placement yields greater primary and secondary patency rates in the long-term. But the mean number of interventions per vein after stenting is significantly higher. Close follow-up and multiple re-interventions are necessary to ensure long-term patency.