Predictive Factors for Successful Endovascular Intervention for Central Venous Occlusive Disease in Hemodialysis Patients.

Background: Central vein stenosis (CVS) and central vein occlusion (CVO) are significant complications in patients undergoing maintenance hemodialysis, often resulting from repeated central venous catheter (CVC) insertions. These conditions can lead to venous hypertension, access dysfunction, upper limb and facial edema, and suboptimal dialysis. Endovascular therapy, particularly percutaneous trans luminal angioplasty (PTA), is the recommended first-line treatment. However, technical success is variable and influenced by lesion characteristics.Aim: To identify predictive factors associated with successful endovascular recanalization of central venous occlusive disease in hemodialysis patients and to evaluate the short-term outcomes of intervention.Patients and Methods: This study included 30 hemodialysis patients (17 females and 13 males; mean age 46±1.90 years, range (16–65) with symptomatic CVO and a functioning ipsilateral arteriovenous (AV) access. Exclusion criteria included thrombosed access, and contraindications to intervention. Preoperative imaging (venography and duplex ultrasound) was performed to confirm diagnosis. PTA was attempted in all patients. In cases where ante grade approach failed, retrograde access was used. Technical success was defined as <30% residual stenosis post-intervention. Follow-up assessments were conducted at 1 week, 1 month, 3 months, and 6 months.Results: Technical success was achieved in 18 of 30 patients (60%). All successful cases maintained 100% primary patency at 6 months with complete symptom resolution. No intra- or post-procedural complications were observed. Univariate analysis identified that lesion length (<4cm), tapered morphology was significantly associated with successful recanalization (p<0.05). Failed cases were characterized by longer lesions (mean length 13cm), abrupt occlusion, and inability to traverse the lesion despite combined approaches. Five failed cases required immediate fistula ligation due to severe edema and ulceration; others showed symptom relief due to collateral development.Conclusion: Endovascular therapy is an effective and safe treatment for central venous occlusion in selected hemodialysis patients. Lesion morphology, length, and location are strong predictors of technical success. Early identification of high-risk lesions can guide clinical decision-making and optimize dialysis access preservation.