Long-term outcomes of stenting superior cava and brachio-cephalic vein occlusion in hemodialysis patients with arteriovenous fistulas

We studied central vein stenting for 21 hemodialysis patients with a mean follow-up of 41 months. Long-term results showed primary and secondary patency rate of 38% and 60% at 36 months. Twelve patients needed at least one reintervention, whereas five patients developed access thrombosis. Three patients required extra-anatomic bypasses, five patients had access failure, and five patients died. Hemodialysis patients with symptomatic occlusion of the superior vena cava or brachiocephalic vein can be successfully recanalized and stented, leading to symptom resolution and, notably, an encouraging secondary patency rate with efficient dialysis. However, a majority of patients will require multiple reinterventions including endovascular percutaneous transluminal angioplasty or extra-anatomical bypass due to symptomatic in-stent restenosis and thrombosis, and a significant number will experience definitive access failure. Central venous obstruction stenting is a valuable initial strategy but should only be performed without compromising further access, as it represents a salvage procedure with important risk of failure during prolonged follow-up.