Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents

Radiology. 1997 Aug;204(2):343-8. doi: 10.1148/radiology.204.2.9240518.

Abstract

Purpose: To determine the effectiveness of using Wallstents to treat subclavian or brachiocephalic venous obstruction after unsuccessful angioplasty, in patients undergoing hemodialysis.

Materials and methods: Dialysis records, radiology reports, and procedural images of 20 hemodialysis patients who underwent Wallstent insertion into a subclavian (n = 11) or brachiocephalic (n = 9) vein were reviewed. Technical success and primary, assisted primary, and cumulative patency rates were calculated.

Results: Twenty-three Wallstents were inserted for stenosis (n = 18) or occlusion (n = 2). Technical success was 100%. Eight patients underwent 11 reinterventions to maintain patency of the Wallstent during the follow-up period. Patency rates of the Wallstent were (a) primary at 1 month, 3 months, 6 months, and 1 year: 90%, 67%, 42%, and 25%; (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 occurred in five patients. One occurred immediately during the deployment procedure, but four were discovered weeks to months later. No other complications 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 surveillance and multiple reinterventions are necessary to maintain Wallstent patency.

MeSH terms

  • Angioplasty
  • Blood Vessel Prosthesis
  • Brachiocephalic Veins*
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Life Tables
  • Male
  • Middle Aged
  • Polytetrafluoroethylene
  • Radiography
  • Renal Dialysis*
  • Stents*
  • Subclavian Vein*
  • Time Factors
  • Treatment Failure
  • Vascular Patency

Substances

  • Polytetrafluoroethylene