title: Long segment recanalization and dedicated central venous stenting in an ultimate attempt to restore vascular access central vein outflow.
abstract: OBJECTIVE
  Maintaining vascular access in patients undergoing chronic hemodialysis is a challenging process, especially in patients enduring multiple central line placements and in whom peripheral options have been exhausted.
  
  
  METHODS
  We present a case of a 60-year-old male without options for peripheral vascular access due to multiple failed arteriovenous fistulas for hemodialysis. Furthermore, bilateral subclavian, brachiocephalic veins and iliac veins were occluded or significantly obstructed. After long segment central vein recanalization, an upper arm loop arteriovenous graft was implanted. The recanalized segment was stented with a 12-mm dedicated venous nitinol stent.
  
  
  CONCLUSIONS
  Chronic central vein obstructions demand stents with both high radial force and flexibility. We recommend dedicated venous stents to improve technical success and reduce stent-related complications like early re-occlusion due to fracturing, kinking or straightening.
authors.affiliation: 1 Department of Radiology, Maastricht University Medical Centre, Maastricht - The Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: de Graaf
authors.forename: Jorinde
authors.initials: J
authors.lastname: van Laanen
authors.forename: Anna
authors.initials: A
authors.lastname: Sailer
authors.forename: Jan
authors.initials: J
authors.lastname: Tordoir
mesh_terms: D000497:Alloys; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003251:Constriction, Pathologic; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011474:Prosthesis Design; D006435:Renal Dialysis; D015607:Stents; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol