title: Comparative outcomes of treated symptomatic versus non-treated asymptomatic high-grade central vein stenoses in the outflow of predominantly dialysis fistulas.
abstract: BACKGROUND
  Witholding treatment in asymptomatic/pauci-symptomatic high-grade central vein stenosis (CVS), i.e. those not causing debilitating painful extremity oedema, the benefits of which have been shown in only one study in grafts, is debatable. The aim of our study was to assess the short- and long-term benefits of such a strategy in mainly autogenous fistulas.
  
  
  METHODS
  We retrospectively compared the outcomes of 53 untreated asymptomatic/pauci-symptomatic and 50 symptomatic high-grade CVS treated by dilation with or without stenting between January 1998 and August 2010 at a single center. Central vein and access patency was estimated by Kaplan-Meier analysis.
  
  
  RESULTS
  Mean age, central catheter use and location of stenosis (brachiocephalic vein) in asymptomatic/pauci-symptomatic and symptomatic CVS were significantly different at 69 versus 75 years, 28 versus 48% and 74 versus 56%, respectively. Ninety percent of the cases had an autogenous fistula. The mean degree of stenosis was >80%. Fourty percent of asymptomatic/pauci-symptomatic CVS became severely symptomatic after 4 years. Primary central vein patency at 3, 12, 24 and 36 months in asymptomatic/pauci-symptomatic and symptomatic CVS were 87±5 versus 82±6, 77±6 versus 55±9, 71±7 versus 35±9 and 67±7 versus 18±9%, respectively (P=0.002). Primary access circuit patency rate was not significantly different between the two groups with 66±5 versus 50±4% at 1 year. Secondary central vein and access circuit patency rates at 1 and 3 years were 100 and 93±7 versus 89±5 and 84±7% (P=0.014).
  
  
  CONCLUSIONS
  Withholding treatment in asymptomatic/pauci-symptomatic CVS in dialysis fistulas yielded significantly better short- and long-term central vein patency than treatment of symptomatic cases without detrimental effects on overall dialysis circuit.
authors.affiliation: University Medical Cluster, National University Health System, Singapore, Singapore. claude_jeffrey_renaud@nuhs.edu.sg
authors.forename: Claude J
authors.initials: CJ
authors.lastname: Renaud
authors.forename: Maud
authors.initials: M
authors.lastname: Francois
authors.forename: Alain
authors.initials: A
authors.lastname: Nony
authors.forename: Mahammed
authors.initials: M
authors.lastname: Fodil-Cherif
authors.forename: Luc
authors.initials: L
authors.lastname: Turmel-Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D055815:Young Adult