Central venous occlusion in haemodialysis patients treated with venous stent at “acceptable patency rates”

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haemodialysis patients cannulationComplications such as central venous occlusion (CVO) and stenoses are among the “challenging” issues that can occur in haemodialysis patients. Now, a group of researchers led by Shimon Aronhime (Shamir Medical Center, Tel Aviv University, Beer Yaakov, Israel) have published findings from a study examining the effectiveness of a dedicated venous stent in these patients.

Aronhime et al reported their experience in treating central venous lesions in haemodialysis patients by conducting a retrospective analysis of patients with CVO treated with a venous stent. A total of 15 patients were treated with the Abre (Medtronic) venous stent and included in the study. Technical success was 100%. Stents were placed across the thoracic inlet in 73% of patients.

Follow-up outcomes were obtained from angiographic images during follow-up angiography and from haemodialysis data. Post-procedure target lesion primary patency was 85% at six months and 70% at 12 months. Primary assisted patency was 93% at both six and 12 months. Importantly, no stent fractures were seen.

“Treatment of CVO remains extremely challenging,” the authors suggest in their conclusion, “especially when the lesion is located at the thoracic inlet.” Dedicated venous stents like the one examined in this trial “provide acceptable patency rates”, and enable patients to continue receiving effective haemodialysis. The authors caution, however, that both routine follow-up as well as reintervention may be required “to maintain patency in the long term”.

Speaking exclusively to Renal Interventions, Aronhime said: “CVO in haemodialysis patients is almost certainly different than CVO in non-haemodialysis patients. Although there are many devices available for the treatment of CVO, what to use when and where is still up for debate. Since venous stents were designed specifically for use in the venous system and have good crush resistance, they may be a good therapeutic option for CVO. In this small retrospective study, we demonstrated that venous stents can adequately treat CVO, even at the thoracic inlet, without the risk of stent fracture. Considering the lack of good surgical options for this patient population, venous stent placement offers patients acceptable patency rates with the ability to continue receiving effective haemodialysis. It will be important to conduct larger, prospective studies in order to validate these results.”

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