Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients.
OBJECTIVE
To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis.


METHODS
A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access (33, 47%) and tunneled catheters (37, 53%) was made. Three cohorts were compared: angioplasty alone (22), bare metal stent (28), and stent graft (20). Patencies were described with Kaplan-Meier method, and Cox uni- and multivariate models were analyzed to find factors associated.


RESULTS
All patients had a favorable anatomical and clinical outcome. Restenosis occurred in 22 (31%) of 70 patients requiring 41 additional interventions; 34 of 70 patients died (median follow-up 19.4 months). Primary patency at 3, 6, 12, and 24 months was 100%, 100%, 100%, and 84% for stent graft versus 90%, 79%, 58%, and 43% for angioplasty (P = .014) versus 84%, 80%, 75%, and 46% for bare-metal stent (P = .062). The overall comparison was more favorable for stent graft (P = .020) when the sites of lesions were matched. Patencies for angioplasty and bare-metal stents were equivalent (P = .141). A lower risk of restenosis (hazard rate [HR] 0.20, confidence interval [CI] 0.06-0.7) and fewer reinterventions (P < .01) were associated with stent graft, whereas age (HR 1.04, CI 1.001-1.08) and cardiovascular disease (HR 2.26, CI 1.06-4.84) influenced the overall survival. No difference in assisted primary patency was found.


CONCLUSIONS
Stent graft seems to improve primary patency for central venous stenosis and requires fewer reinterventions in a dialysis population with a high prevalence of long-term catheters.
Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy p.quaretti@smatteo.pv.it.
Pietro
P
Quaretti
Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy.
Franco
F
Galli
Unit of Interventional Radiology-Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Lorenzo Paolo
LP
Moramarco
Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Riccardo
R
Corti
Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Giovanni
G
Leati
Radiology Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Ilaria
I
Fiorina
Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Carmine
C
Tinelli
Nephrology and Dialysis, IRCCS Fondazione Salvatore Maugeri, Pavia, Italy.
Giovanni
G
Montagna
Department of Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Marcello
M
Maestri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D010690:Phlebography; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency
D008670:Metals
angioplasty; bare metal stent; central venous stenosis; hemodialysis; stent graft; superior vena cava syndrome; vascular access