Endovascular management of central venous occlusive disease in hemodialysis patients with symptomatic venous hypertension

Aim
The aim was to evaluate the feasibility and efficacy of balloon angioplasty in hemodialysis patients with venous hypertension.
Materials and methods
A prospective study was carried out from April 2017 to October 2019 at 6 October Insurance Hospital, Cairo, and Sohag University Hospitals on 32 patients with end-stage renal disease on hemodialysis complaining of venous hypertension owing to central vein occlusive disease treated with balloon angioplasty with or without stenting. Bailout stent was deployed in cases of significant residual stenosis more than 30% or venous recoil.
Results
The commonest site of central vein occlusion was the innominate vein in 21 (65.6%) patients. Technical success was achieved in 26 (81.3%) patients; 20 of them operated by balloon angioplasty and six achieved after stent deployment. Technical failure occurred in six (18.8%) patients. Overall primary patency rate was 76.9, 57.7, and 46.2% at 3, 6, and 12 months, respectively. Primary patency rate was 80, 65, and 55% at 3, 6, and 12 months, respectively, in those treated with balloon angioplasty, whereas it was 66.6, 33.3, and 33.3% at 3, 6, and 12 months, respectively, in those treated with stent deployment (=0.17). Reocclusion was recorded in 14 (53.8%) of 26 patients; nine of them were previously managed by balloon dilatation, whereas the other five patients were previously managed by stent deployment. Of 14 cases, 7 were managed successfully by balloon dilatation, 2 of 14 patients were treated by stent deployment, whereas in 5 of 14 cases, revascularization failed. Analysis of data of failed cases denoted that 4/5 of them were in-stent occlusions and one case occluded after percutaneous angioplasty.
Conclusion
Balloon angioplasty for central vein occlusive disease in hemodialysis patients achieves comparable patency rates and clinical outcomes to venous stent. Although it achieves short-term durability, it should be applied firstly reserving the venous stent for significant residual stenosis.