Central Vein Stenosis in patients undergoing Hemodialysis through Arteriovenous Access: Experience from a University Hospital of Nepal
DOI:
https://doi.org/10.63666/ejsmr.1694-9013.4.I.2026.97Keywords:
Arteriovenous fistulas, Balloon Angioplasty, Central Venous Catheterizations, HemodialysisAbstract
Introduction: Adequate delivery of hemodialysis is only possible through effective access. This is most commonly achieved through an arteriovenous fistula, followed by an arteriovenous graft, and tunneled cuffed catheter. Central vein stenosis is a common and troublesome issue in patients undergoing hemodialysis through arteriovenous access, usually due to preexisting temporary internal jugular catheter or permanent cuffed tunneled catheter. They commonly present with swelling of the neck, breasts and extremities. Some of the major predisposing factors for development of CVS are placement of multiple catheters, longer duration, location in subclavian vein, and placement on the lefthand side of the neck.
Objective: The main aim of this study is to identify the interventions done for failed arteriovenous fistulas and evaluate the cases feasible for balloon angioplasty.
Methods: This is a retrospective descriptive cross-sectional study where all the cases of angiograms with or without angioplasty for stenosis in drainage of arterio-venous fistulas created for dialysis access from October 1st 2020, to January 31s 2022, were included in the study. In each case, detailed imaging of drainage and the presence of central vein stenosis were noted. The possibility of balloon angioplasty for the central vein stenosis was noted, along with the outcome after the procedure.
Results: There were 62 interventions for failed arteriovenous fistulas. Of them, central vein stenosis was present in 27 cases (43.5%), which included 16 (59.3%) males and 11 (40.7%) females. In 26 patients (96.3%), there was a history of catheterization involving the central vein at least once. The number of cases with a history of catheterization in the involved vein for one time, two times, or more than two times was 6 (22.2%), 15 (55.6%), and 4 (14.8%), respectively. Prominent visible collateral was present in 11 (40/7%) patients, with the most common sites being both the neck and chest (5 cases). The most common indication of intervention was swelling, present in 22 (81.5%) cases. Innominate veins were involved in 15 (55.5%) cases. Negotiation of a catheter via stenosis was feasible in 15 cases (55.6%), while balloon angioplasty was possible in 6 (22.2%) cases.
Conclusion: Central vein stenosis can cause fistula failure. The primary intervention done in these cases includes balloon angioplasty; however, stenting can be done if this fails.
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