Stenting of proximal venous obstructions to maintain hemodialysis access.
OBJECTIVE
The purpose of the study was to evaluate the efficacy of stenting central venous obstructions in patients dependent on hemodialysis to preserve or restore central venous patency and allow for continued hemodialysis from the affected side.


METHODS
Twenty-five self-expanding (17) and balloon-expandable (8) stainless steel stents were deployed in 19 patients with end-stage renal disease and central venous stenosis or occlusion. Nineteen lesions were treated: 11 subclavian and eight innominate. Twenty-two stents were initially implanted.


RESULTS
Stent deployment was successful in all cases and immediately remedied the underlying cause of venous hypertension. Follow-up at up to 17 months revealed three deaths from unrelated causes, one occlusion at 3.25 months, and three restenoses at 16 days, 2.5 and 5 months, respectively, with successful implantation of three additional stents for a primary central patency rate of 68% (+/- 14%) and secondary central patency rate of 93% (+/- 7%).


CONCLUSIONS
Stenting of subclavian and innominate venous stenoses and occlusions effectively corrected the underlying lesions responsible for disturbed hemodynamics and, in most cases, prolonged available hemodialysis access from the affected side. Stents seem to be valuable adjuncts in the management of failing hemodialysis access due to central venous stenosis or occlusion.
Shoenfeld
R
R
Department of Radiology, Newark Beth Israel Medical Center, NJ 07112.
Hermans
H
H
Novick
A
A
Brener
B
B
Cordero
P
P
Eisenbud
D
D
Mody
S
S
Goldenkranz
R
R
Parsonnet
V
V
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001132:Arm / Q000098:blood supply*; D016121:Brachiocephalic Veins / Q000601:surgery; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D013193:Stainless Steel; D015607:Stents; D013350:Subclavian Vein / Q000601:surgery; D013924:Thrombophlebitis / Q000601:surgery; D014654:Vascular Patency; D014680:Veins / Q000601:surgery
D013193:Stainless Steel; D011138:Polytetrafluoroethylene