Endovascular intervention for central venous stenosis in hemodialysis patients

Abstract

Objective: To evaluate the technical and clinical outcomes of endovascular intervention for AVF-related central venous stenosis or occlusion (CVSO) in hemodialysis patients at Thong Nhat Hospital, Ho Chi Minh City.

Methods: A retrospective, descriptive case-series study was conducted on 37 end-stage renal disease patients on maintenance hemodialysis with DSA-confirmed CVSO, treated at the Department of Cardiothoracic and Vascular Surgery, Thong Nhat Hospital, between January 2021 and January 2025. Interventions included PTA alone or combined with stent placement.

Results: Mean age was 46.1 ± 13.2 years; males comprised 48.6%. Mean time from AVF creation to CVSO diagnosis was 42.37 ± 27.14 months. The subclavian vein was most frequently affected (54.1%). Technical success was achieved in 88.5% of cases; PTA alone was performed in 83.8%. Post-intervention, 90.6% had reduced arm edema, 71.4% had pain relief, and 94.6% maintained AVF thrill enabling continued hemodialysis. Comparative analysis revealed significantly lower 6-month restenosis in the PTA + stent group vs. PTA alone (0.0% vs. 29.0%, p = 0.04), and longer patency (13.9 ± 4.3 vs. 8.4 ± 3.6 months, p = 0.03).

Conclusion: Endovascular intervention is a safe, effective treatment for CVSO in hemodialysis patients, preserving AVF function and maintaining dialysis efficacy. PTA is the preferred first-line approach; stenting should be prioritized for severe, recurrent, or highly elastic lesions.