CHRONIC VENOUS OCCLUSIONS IN HEMODIALYSIS SHUNTS - EFFICACY OF PERCUTANEOUS TREATMENT

Purpose. The efficacy of percutaneous treatment of chronic venous occl usions in haemodialysis fistulae was retrospectively analysed. Materia ls and method. In 33 cases, percutaneous treatment of chronic venous o cclusions was attempted. The type of shunt was an autologous arteriove nous fistula in 23 cases and a PTFE implant graft in 10 cases. The les ion involved forearm veins in six cases, an upper arm vein in 15 cases , and a central vein in 12 cases. The mean length of the occlusion was 7.4 +/- 5 cm with a range from 2 to 25 cm. Fresh thrombus material in addition to the chronic occlusion was present in five cases. The pati ents were referred for chronic shunt dysfunction in 29 cases and with acute shunt thrombosis with an underlying chronic venous occlusion in four cases. Results. Mechanical recanalization succeeded in 27 of 33 o cclusions (82%). In one further patient, direct recanalization failed but an alternative improved drainage was created by detouring the main Venous outflow tract by the use of a stent. Immediate clinical succes s was therefore 85%. Simple balloon dilatation was used in 11 of 27 ca ses (41%). Additional stent implantation became necessary in 16 of 27 cases (59%). In 15 patients an event of reobstruction occurred during follow-up. Mean primary cumulative patency was 85% after treatment, 41 % after 6 months, and 24% after 2 years. By use of reintervention shun t function was maintained at 74% up to 2 years. Conclusions. Percutane ous treatment of chronic venous occlusions is technically feasible wit h a success Similar to treatment of stenotic lesions. Follow-up result s do not show impaired follow-up data for that type of obstruction.