UPPER EXTREMITY CENTRAL VENOUS OBSTRUCTION IN HEMODIALYSIS-PATIENTS -TREATMENT WITH WALLSTENTS

PURPOSE: To determine the effectiveness of using Wallstents to treat s ubclavian or brachiocephalic venous obstruction after unsuccessful ang ioplasty, in patients undergoing hemodialysis. MATERIALS AND METHODS: Dialysis records, radiology reports, and procedural images of 20 hemod ialysis patients who underwent Wallstent insertion into a subclavian ( n = 11) or brachiocephalic (n = 9) vein were reviewed. Technical succe ss and primary, assisted primary, and cumulative patency rates were ca lculated.RESULTS: Twenty-three Wallstents were inserted for stenosis ( n = 18) or occlusion (n = 2). Technical success was 100%. Eight patien ts underwent 11 reinterventions to maintain patency of the Wallstent d uring the follow-up period. Patency rates of the Wallstent were (a) pr imary at I month, 3 months, 6 months, and I year: 90%, 67%, 42%, and 2 5%; (b) assisted primary at 3 months, 6 months, and 1 year: 88%, 62%, and 47%; and (c) cumulative at 3 months, 6 months, 1 year, and 2 years : 89%, 64%, 56%, and 22%. Considerable shortening of the stent occurre d in five patients. One occurred immediately during the deployment pro cedure, but four were discovered weeks to months later. No other compl ications occurred. CONCLUSION: After suboptimal angioplasty, treatment of subclavian and brachiocephalic vein stenoses with a Wallstent can provide continued use of a hemodialysis access. Close clinical surveil lance and multiple reinterventions are necessary to maintain Wallstent patency.