Chronic venous occlusions in haemodialysis shunts: efficacy of percutaneous treatment.
OBJECTIVE
The efficacy of percutaneous treatment of chronic venous occlusions in haemodialysis fistulae was retrospectively analysed.


METHODS
In 33 cases, percutaneous treatment of chronic venous occlusions was attempted. The type of shunt was an autologous arteriovenous fistula in 23 cases and a PTFE implant graft in 10 cases. The lesion involved forearm veins in six cases, an upper arm vein in 15 cases, and a central vein in 12 cases. The mean length of the occlusion was 7.4 +/- 5 cm with a range from 2 to 25 cm. Fresh thrombus material in addition to the chronic occlusion was present in five cases. The patients were referred for chronic shunt dysfunction in 29 cases and with acute shunt thrombosis with an underlying chronic venous occlusion in four cases.


RESULTS
Mechanical recanalization succeeded in 27 of 33 occlusions (82%). In one further patient, direct recanalization failed but an alternative improved drainage was created by detouring the main venous outflow tract by the use of a stent. Immediate clinical success was therefore 85%. Simple balloon dilatation was used in 11 of 27 cases (41%). Additional stent implantation became necessary in 16 of 27 cases (59%). In 15 patients an event of reobstruction occurred during follow-up. Mean primary cumulative patency was 85% after treatment, 41% after 6 months, and 24% after 2 years. By use of reintervention shunt function was maintained at 74% up to 2 years.


CONCLUSIONS
Percutaneous treatment of chronic venous occlusions is technically feasible with a success similar to treatment of stenotic lesions. Follow-up results do not show impaired follow-up data for that type of obstruction.
Vorwerk
D
D
Department of Diagnostic Radiology, Technical University of Aachen, Germany.
Bücker
A
A
Alzen
G
G
Schürmann
K
K
Ritzerfeld
M
M
Günther
R W
RW
D000368:Aged; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002404:Catheterization; D003251:Constriction, Pathologic; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D014680:Veins