title: Central vein stenosis in an Asian hemodialysis population.
abstract: OBJECTIVE
  Central vein stenosis occurs commonly after instrumentation of the major thoracic veins. We aimed to investigate factors that contributed to this condition in an Asian hemodialysis population, and the results of intervention.
  
  
  METHODS
  Hemodialysis patients diagnosed with central vein stenosis between January 2003 and December 2008, were identified from the records of the National University Hospital, Singapore. Eligible controls had a minimum of 2 years of hemodialysis via an arteriovenous fistula and/or central venous catheter, without clinical or radiological evidence of central vein stenosis.
  
  
  RESULTS
  Central vein stenosis was diagnosed in 108 patients. The most common presenting features were arm swelling (32%) and failed hemodialysis catheter insertion (28%). The median frequency of permanent hemodialysis catheter insertion in those who subsequently developed venous stenosis (1.44 per patient per year) was 4 times that of controls (0.36 per patient per year; p<0.001). Ischemic heart disease (p = 0.03) and in certain patients, arteriovenous fistula surgery were associated with the development of central vein stenosis; whereas line sepsis, diabetes, and hypertension were not. Central vein angioplasty was attempted in 53 patients; the primary patency was 52% at 1 year.
  
  
  CONCLUSIONS
  Central vein stenosis is associated with a higher frequency of hemodialysis catheter insertion and access surgery. Efforts to decrease permanent hemodialysis catheter use should reduce the incidence of central vein stenosis.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Thwaites
authors.forename: Peter A
authors.initials: PA
authors.lastname: Robless
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D044466:Asian People; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004487:Edema / Q000208:ethnology / Q000209:etiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015607:Stents; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000628:therapy; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency