Upper extremity central venous obstruction in hemodialysis patients: Treatment with Wallstents

Thomas M. Vesely, David M. Hovsepian, Thomas K. Pilgram, Daniel W. Coyne, Surendra Shenoy

Research output: Contribution to journalArticle

110 Scopus citations

Abstract

PURPOSE: To determine the effectiveness of using Wallstents to treat subclavian or brachiocephalic venous obstruction after unsuccessful angioplasty, in patients undergoing hemodialysis. MATERIALS AND METHODS: Dialysis records, radiology reports, and procedural images of 20 hemodialysis patients who underwent Wallstent insertion into a subclavian (n = 11) or brachiocephalic (n = 9) vein were reviewed. Technical success and primary, assisted primary, and cumulative patency rates were calculated. RESULTS: Twenty-three Wallstents were inserted for stenosis (n = 18) or occlusion (n = 2). Technical success was 100%. Eight patients underwent 11 reinterventions to maintain patency of the Wallstent during the follow-up period. Patency rates of the Wallstent were (av) primary at 1 month, 3 months, 6 months, and 1 year: 90%, 67%, 42%, and 25%; (b) assisted primary at 3 months, 6 months, and 1 year: 88%, 62%, and 47%; and (c) cumulative at 3 months, 6 months, 1 year, and 2 years: 89%, 64%, 56%, and 22%. Considerable shortening of the stent occurred in five patients. One occurred immediately during the deployment procedure, but four were discovered weeks to months later. No other complications occurred. CONCLUSION: After suboptimal angioplasty, treatment of subclavian and brachiocephalic vein stenoses with a Wallstent can provide continued use of a hemodialysis access. Close clinical surveillance and multiple reinterventions are necessary to maintain Wallstent patency.

Original languageEnglish
Pages (from-to)343-348
Number of pages6
JournalRadiology
Volume204
Issue number2
DOIs
StatePublished - Aug 1997

Keywords

  • Dialysis, shunts
  • Veins, grafts and prostheses
  • Veins, innominate
  • Veins, stenosis or obstruction
  • Veins, subclavian

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