HDCN Article Review/Hyperlink

Mickley V, Gorich J, Rilinger N, Storck M, Abendroth D

Stenting of central venous stenoses in hemodialysis patients: Long-term results

Kidney Int (Jan) 51:277-280 1997

Stenosis of central veins is a major problem in dialysis patients who have received central venous catheters, particularly in the subclavian position. In this admittedly small series of patients (n=14) with primarily subclavian vein occlusions, all of whom had subclavian catheters, the occlusions were treated by dilatation and stent insertion. Stents were placed via the femoral vein, although sometimes a distal catheter also had to be inserted to open up the occlusion. A rotating device (Rotacs) was used to open two short occlusions, and all stents required balloon dilatation after placement to allow for complete opening. Patients were placed on heparin for 3 days postoperatively and maintained on aspirin 100 mg/day.

Initial success rate was 100%. Arm swelling (n=11) and facial swelling (n=2) resolved promptly after the procedure. Four patients died of unrelated causes 7-24 months after stent placement. Arm or face swelling recurred after 3-16 months with 6 stents, and this recurrence seemed to be due to new stenoses adjacent to widely patent stents. Cumulative primary patency was 70% and 50% at 1 and 2 years, whereas cumulative secondary patency was 100 and 85% at 1 and 2 years, respectively.

Comment: Although this is a small series, it shows that venovenous bypass surgery can be avoided in many patients with such lesions. We no longer use subclavian catheters for this reason, but patients in whom subclavian catheters were placed in the past continue to present with subclavian or brachiocephalic vein occlusion. (John T. Daugirdas, M.D., University of Illinois at Chicago)