Document Detail


Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients.
MedLine Citation:
PMID:  17398386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Central (superior vena cava, brachiocephalic, or subclavian) venous stenoses are a major impediment to long-term arteriovenous access in the upper extremities. The optimal management of these stenoses is still undecided. The purpose of this study was to determine the outcomes of primary angioplasty (PTA) vs primary stenting (PTS) in a dialysis access population at a tertiary referral academic medical center.
METHODS: A database of consecutive hemodialysis patients undergoing endovascular treatment for central venous stenosis was developed for the period 1995 through 2003. This database was retrospectively reviewed. Vessels exposed to either primary high-pressure balloon angioplasty or primary stenting were examined. Vessels undergoing stenting after failed or suboptimal angioplasty were defined as failures at the time of stenting despite the potential continued patency upon completion of stenting. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Cox proportional hazards analysis was performed for time-dependent variables. Data are presented as mean +/- standard deviation where appropriate.
RESULTS: PTS was used to treat 26 patients (35% male; average age, 57 +/- 15 years) with 26 central venous stenoses, and 47 patients (45% male; average age, 57 +/- 18 years) with 49 central venous stenoses were treated with PTA. The PTS group underwent 71 percutaneous interventions per stenosis (average, 2.7 +/- 2.4 interventions), and the PTA group underwent 98 interventions per stenosis (average, 2.0 +/- 1.6 interventions). The PTS group hemodialysis access site was an average of 1.0 +/- 1.3 years old at the time of the initial intervention, and the hemodialysis access in the PTA group was an average of 1.1 +/- 1.2 years old. Primary patency was equivalent between groups by Kaplan-Meier analysis, with 30-day rates of 76% for both groups and 12-month rates of 29% for PTA and 21% for PTS (P = .48). Assisted primary patency was also equivalent (P = .08), with a 30-day patency rate of 81% and 12-month rate of 73% for the PTA group, vs PTS assisted patency rates of 84% at 30 days, and 46% at 12 months. Ipsilateral hemodialysis access survival was equivalent between groups.
CONCLUSIONS: Endovascular therapy with PTA or PTS for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule with both treatments. Although neither offers truly durable outcomes, PTS does not improve on the patency rates more than PTA and does not add to the longevity of ipsilateral hemodialysis access sites.
Authors:
Andrew M Bakken; Clinton D Protack; Wael E Saad; David E Lee; David L Waldman; Mark G Davies
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  45     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-02     Completed Date:  2007-05-17     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  776-83     Citation Subset:  IM    
Affiliation:
Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Balloon*
Arteriovenous Shunt, Surgical / adverse effects
Blood Vessel Prosthesis Implantation / adverse effects
Brachiocephalic Veins*
Catheterization, Central Venous / adverse effects
Constriction, Pathologic / etiology,  therapy
Female
Follow-Up Studies
Graft Occlusion, Vascular / etiology,  physiopathology,  therapy*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Renal Dialysis* / methods
Reoperation
Retrospective Studies
Risk Factors
Stents*
Subclavian Vein*
Superior Vena Cava Syndrome / etiology,  physiopathology,  therapy*
Time Factors
Treatment Failure
Treatment Outcome
Vascular Patency
Venous Thrombosis / etiology,  physiopathology,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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