Asymptomatic central venous stenosis in hemodialysis patients.
OBJECTIVE
To retrospectively evaluate the natural history of high-grade (>50%) asymptomatic central venous stenosis (CVS) in hemodialysis patients and the outcome of serial treatment of CVS with percutaneous transluminal angioplasty (PTA).


METHODS
The institutional review board granted exemption for this retrospective study, the need for informed consent was waived, and all data collection was in compliance with HIPAA. Patients with hemodialysis access requiring maintenance procedures between 1998 and 2004 and incidentally found to have ipsilateral (> or =50%) CVS were identified from a departmental database. Thirty-five patients (19 men, 16 women; mean age, 58.7 years) with 38 grafts met inclusion criteria, and 86 venograms were reviewed. CVS was measured by using venograms obtained before and after PTA, if performed. Patients with arm swelling, multiple CVS, indwelling catheters, and stents at the first encounter were excluded. CVS progression was calculated by dividing the change in the degree of stenosis by the time between venographic examinations. Wilcoxon rank sum test was used to evaluate differences in rate of CVS progression between treated and nontreated patients.


RESULTS
Mean degree of CVS before intervention was 71% (range, 50%-100%). Sixty-two percent (53 of 86) of lesions had associated collateral vessels; 28% (24 of 86) of CVSs were not treated. Mean degree of stenosis in this group was 72% (range, 30%-100%); mean progression was -0.08 percentage point per day. No untreated CVS progressed to symptoms, stent placement, or additional CVS. Seventy-two percent (62 of 86) of CVSs were treated with PTA. Mean degree of stenosis in this group was 74% (range, 50%-100%) before and 40% (range, 0%-75%) after treatment; mean progression was 0.21 percentage point per day after treatment (P = .03). Six (8%) of 62 treatments were followed by CVS escalation; one patient developed arm swelling, four required stents, and four developed additional CVS.


CONCLUSIONS
PTA of asymptomatic CVS greater than 50% in the setting of hemodialysis access maintenance procedures was associated with more rapid stenosis progression and escalation of lesions, compared with a nontreatment approach.
Levit
Rebecca D
RD
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Philadelphia, 19104, USA.
Cohen
Raphael M
RM
Kwak
Andrew
A
Shlansky-Goldberg
Richard D
RD
Clark
Timothy W I
TW
Patel
Aalpen A
AA
Stavropoulos
S William
SW
Mondschein
Jeffrey I
JI
Solomon
Jeffrey A
JA
Tuite
Catherine M
CM
Trerotola
Scott O
SO
D000800:Angioplasty, Balloon; D001132:Arm / Q000098:blood supply; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric