Endovascular Management of Central venous Occlusion in the Hemodialysis Patients

Background: Central vein occlusion (CVO) is a frequent complication in end-stage renal disease (ESRD) patients undergoing regular hemodialysis (HD). Percutaneous transluminal angioplasty (PTA), with or without stenting, has become the primary treatment method for this condition.Objective: To evaluate the effectiveness and safety of PTA, with or without stenting, in treating CVO in hemodialysis patients.Patients and Methods: This prospective study included 30 ESRD patients on hemodialysis who exhibited symptoms of venous hypertension such as arm and facial edema, painful hand, color changes like cyanosis, ulceration, distended collateral veins on the chest wall, impaired flow during dialysis, or prolonged bleeding from the access puncture site post-dialysis. Patients underwent duplex ultrasonography, venography, nerve conduction studies, and consultations with cardiology and nephrology before receiving PTA using balloons or venous stents.Results: The key predictors of technical success for PTA, with or without stenting, included the type of AV access (BCF+BBF/AVBG), type of lesion (stenosis/occlusion), and the length of the affected segment (<5 cm). Post-intervention, there were statistically significant improvements in pain, swelling, and dilated chest and neck veins. However, there was no significant improvement in ulceration, cyanosis, or impaired finger function. There was no statistically significant difference in patency rates between PTA with stenting (100%) and without stenting (76.5%).Conclusion: PTA enhances primary patency for treating central vein stenosis or occlusion in hemodialysis patients, with no significant difference in patency rates between procedures with or without stenting.