Outcome of percutaneuos transluminal angioplasty with and without stenting of central venous stenosis in heamodialysis patients.

Background: Patients receiving hemodialysis frequently have access dysfunction and morbidity as a result of central venous occlusion and stenosis. The ongoing advancement of technology, has rendered percutaneous transluminal angioplasty (PTA)—with or without stenting—a safer and more reliable procedure than alternatives involving surgery.Objectives: Evaluation of the efficacy and safety of the endovascular treatment of central venous stenosis (CVS) in hemodialysis patients.Patients and Methods: 56 patients with end-stage renal disease who were receiving regular hemodialysis and had central venous stenosis at Cairo University Hospitals' Vascular Surgery Department were included in this prospective research. All patients were treated with percutaneous transluminal angioplasty, either with or without stenting, between April 2020 and March 2023. Patients were told about the operation, its risks, advantages, and alternative interventions, and their informed consent was acquired. Planned follow-ups were at 1,3,6, 9, and 12 months. The major goal of this study was to assess the primary and assisted patency rates. Results: The study was conducted on 56 patients with end-stage renal disease, comprising 31 males and 25females. The mean age was 51.89±14.11 years. Forty-eight (85.7%) patients were treated initially with balloon angioplasty only, and only 8 venous stents were initially deployed. Technical success was achieved in 100% of patients. One-year primary patency rate was 83.9%, 55.6%, 32.1% and 21.4% at 3, 6, 9 months and 1 year respectively in all patients. Assisted patency rates were 87.5%, 71.4%, 57.1% and 42.9% at 3, 6, 9 months and 1 year respectively in all patients. Conclusion: Endovascular treatment of central venous stenosis is a safe and effective technique in hemodialysis patients, with acceptable primary and assisted patency rates. However, in some cases, multiple PTA is needed. Venous stenting should only be utilized in cases with PTA-resistant lesions or frequent stenosis and occlusions.