Treatment of hemodialysis-related central venous stenosis or occlusion: Results of primary Wallstent placement and follow-up in 50 patients

PURPOSE: To analyze the effectiveness of stent placement as the primary tre atment for central venous obstruction in patients undergoing hemodialysis. MATERIAL AND METHODS: Fifty-seven Wallstents were placed in 50 patients wit h symptomatic shunt dysfunction and arm swelling due to central venous obst ruction. Technical success, complication, and patency rates were evaluated. RESULTS: Stent deployment was successful in all patients, and early rethrom bosis (within 1 week) was noted in one patient (2%). Seventy-three episodes of reobstruction occurred and were treated percutaneously with angioplasty alone in 54 cases (74%). Nineteen cases (26%) necessitated additional sten t placement. The 3-, 6-, 12-, and 24-month primary patency rates were 92%, 84%, 56%, and 28%, respectively. Cumulative overall stent patency was 97% a fter 6 and 12 months, 89% after 24 months, and 81% after 36 and 48 months. CONCLUSION: In the treatment of brachiocephalic and subclavian venous obstr uction, stent placement shows excellent technical results and helps preserv e vascular access for a substantial period. Multiple repeat interventions a re, however, frequently required to maintain patency.