AbstractBackground: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency.
Aims: The objective of this study was to describe our initial experience in the endovascular treatment of central venous disease in patients with prolonging hemodialysis fistula.
Methods: A prospective study included 19 patients with chronic renal failure who underwent hemodialysis fistula in the upper limb and presented with signs and symptoms of central venous disease or stenosis and referred from the cardiovascular surgery clinic during the period from November 2019 to May 2021. Their age ranged from 24-70 years. Patients underwent Doppler ultrasound examination of the upper limb and prepared for fistulography and subsequent PTA (percutaneous transluminal angioplasty).
Results: 19 patients presented with signs of central venous disease were included in this study, 13 are males and 6 are females. Their ages ranged between 24-70 years.
The total number of lesions detected was 27 as some of the patients had 2 or three lesions. The majority of lesions and limb swelling were on the RT side and represent 79%, while regarding the anatomical locations of these lesions, the majority were involving the brachiocephalic and subclavian veins and this represent 74% of the lesions
Regarding the severity of stenosis detected by fistulography, the majority of lesions were either severe stenosis or total occlusion and this represents 44.4% and 37% respectively. PTA was done in only 15 patients, 13 patients underwent PTA using traditional PTA using armada Balloon of size ranging from 8x40mm for smaller lesion or as start with balloon in the tight lesion, while 14x40 mm balloon was used for subclavian, brachiocephalic and SVC lesions, there is good response seen in 13/15 lesions (86.6%), one failed attempt seen in a patient with total right brachiocephalic occlusion, and last one had significant recoil with good contrast run on angiography.
Conclusion: endovascular treatment of central venous disease using PTA is an efficient, safe, and cost-effective method in the treatment of upper limb +/- head and neck swelling in patients with hemodialysis and reliable in decreasing the hemodialysis session time and post-procedure prolong bleeding, thus decreasing the rate of future surgical intervention and substitute creating new fistula in other limbs.
