Search
"Central venous occlusive disease is a common cause of upper extremity, arteriovenous (AV) access dysfunction in hemodialysis patients" Proksch et al (2021).

Abstract:

Introduction: Central venous occlusive disease is a common cause of upper extremity, arteriovenous (AV) access dysfunction in hemodialysis patients. When refractory to balloon angioplasty, treatment options include central venous stenting and the Hemodialysis Reliable Outflow (HeRO) graft. The purpose of this study is to evaluate the outcomes of these options.

Methods: A retrospective review was performed of patients who underwent central venous stenting or HeRO placement for central venous obstruction between December 2008 and March 2018. Primary outcomes were re-intervention rates, patency, and mortality.

Results: Seventy-five hemodialysis patients were identified after failed balloon angioplasty for central venous obstruction. Forty-four patients underwent central venous stenting comprising coverage of the subclavian vein (27), innominate vein (18), or superior vena cava (5). Six stent patients later underwent HeRO placement. The utilized stents were 65% stent grafts (Viabahn (9), Fluency/Flair (19), iCast (2), and other (1)) and 35% bare metal stents (Wall-stent (6), Protégé (1), Cobalt (1), or other (9)). Thirty-one HeROs were placed. The venous outflow component insertion sites were internal jugular (20), external jugular (1), subclavian (6), axillary (2), or other (2). The stent and HeRO groups were similar in previous central venous intervention rates; 0.6 (0-3.0) versus 3.5 (0-10.1) per year (p = 0.679). After the index procedure, there was no difference between groups in frequency of dialysis circuit interventions per year (2.0 (0-6.0) vs. 2.0 (0-7.0); p = 0.291) nor central venous interventions (i.e. angioplasties of the central veins or within the portion of the HeRO inside central veins) per year (2.0 (0-4.1) vs. 0 (0-2.4); p = 0.419). One-year access circuit primary patency was 8.1% for stenting and 22.2% for HeRO (p = 0.109). Two-year access circuit secondary patency was 40.0% for stenting and 52.4% for HeRO (p = 0.401). All-cause mortality was similar at 1 year (3.7% vs. 4.8%; p = 0.856) and 2 years (11.8% vs. 23.5%; p = 0.368).

Conclusions: Central venous stenting and HeRO were shown to have similar rates of re-intervention and patency. This study suggests the multiple treatment options for this problematic disease process may yield similar results when careful patient selection is applied.

Reference:

Proksch DM, Rodriguez LE, Rathore A, Steerman SN, Panneton JM. A comparison of stenting versus HeRO for hemodialysis patients with recurrent central venous obstructions. J Vasc Surg Venous Lymphat Disord. 2021 Jan 13:S2213-333X(21)00002-0. doi: 10.1016/j.jvsv.2021.01.001. Epub ahead of print. PMID: 33453441.