Document Detail


Treatment of refractory central vein stenosis in hemodialysis patients with stents.
MedLine Citation:
PMID:  17244127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Central venous stenosis is a frequent complication in hemodialysis patients, which can manifest clinically with ipsilateral upper extremity edema. When symptomatic, it is usually treated by percutaneous transluminal angioplasty. When angioplasty is unsuccessful, stent deployment is a therapeutic option. The goal of the present study was to evaluate the primary and secondary patency of refractory central vein stenosis after treatment with a stent. Using a prospective vascular access database we retrospectively identified 23 patients presenting with unilateral upper extremity edema and a significant (> 50%) central vein stenosis, who underwent stent placement due to refractory stenosis following angioplasty. The primary (unassisted) central vein patency was determined from the initial intervention to the next angioplasty for recurrent central vein stenosis, and the secondary (assisted) patency from the initial intervention to permanent central vein occlusion. An immediate technical success was achieved in all patients after the stent deployment. However, the median primary central vein patency was only 138 days, with a 19% patency at 1 year. Recurrence of ipsilateral edema was always due to in-stent restenosis. The median secondary central vein patency was 1036 days, with a 64% patency at 1 year. In patients with symptomatic central vein stenosis that is refractory to percutaneous transluminal angioplasty, stent deployment provides short-term relief of the stenosis and ipsilateral upper extremity edema. However, long-term symptomatic relief can be achieved with multiple subsequent interventions in many patients.
Authors:
Ivan D Maya; Souheil Saddekni; Michael Allon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Seminars in dialysis     Volume:  20     ISSN:  0894-0959     ISO Abbreviation:  Semin Dial     Publication Date:    2007 Jan-Feb
Date Detail:
Created Date:  2007-01-24     Completed Date:  2007-04-03     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  78-82     Citation Subset:  IM    
Affiliation:
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon
Arteriovenous Shunt, Surgical
Catheterization, Central Venous / adverse effects*
Catheters, Indwelling / adverse effects*
Constriction, Pathologic / etiology,  therapy
Female
Humans
Male
Middle Aged
Recurrence
Renal Dialysis*
Retrospective Studies
Stents*
Vascular Patency
Grant Support
ID/Acronym/Agency:
1K24DK59818-01/DK/NIDDK NIH HHS

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