Wei Liang, MD

Jiwei Zhang, Peng Wang, Kai Yuan

Endovascular treatment for central venous

stenosis in hemodialysis patients

Disclosure

Speaker name: Wei Liang

.................................................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest×

Central venous stenosis (CVS)

Swollen Arm

Varicose Vein

Skin Ulcer

CVS Incidence: 8.79% in HD

(From 14 Hospitals in China)

BMJ Open 2015, 5

Typical Case

• Female, 60yrs

• R. upper arm AVF 3 yrs

• Varicose vein and edema for

2M in R. upper arm

• SVC filter & R. jugular V

catheter for HD 2M ago

R cephalic V

R Sub-BC

SVC filter

R Jugular V

catheter

1st . 2016, Sept 19• Angiography

• Retrieve SVC filter

• Cross the lesion, PTA+Stent

E-Luminexx 12-80mmPTA 8-40mm, 10-40mm

2nd. 2017, July 31: PTA

Pre- PTA 10-40mm

3rd. 2018, Feb 14: PTA

Pre- PTA 12-40mm

4th. 2018, Apr 4: Stent

Pre- Wallstent 14-90mm

5th. 2018, June 4: PTA

Pre PTA 10-40mm

6th. 2018, July 13: Stent (CS)

Pre- VIABAHN 13-100mm

Our Experience – Renji Hospital

Aug, 2014 – Dec, 2018

31 cases AVF 25, AVG 6

Age 66.1Y (37-86)

Male/Female 14/17

Duration of hemodialysis(M)

39.1±20.3 （6-70）

Past CV Cannulation

23 (74.2%)

Our Experience – Renji Hospital

Clinic Manifestation

Edema 31

Pigment 10

Varicose Vein 31

Skin Ulcer 3

Our Experience – Renji Hospital

Right (17) Left (14)

Ceph-Sub

Sub+BC

Sub BC BC-SVC

Ceph-Sub

Sub+BC

Sub BC BC-SVC

Steno. 1 0 1 2 1 1 2

Occl. 6 1 3 3 1 4 3 2

Total 1 6 2 5 3 1 5 4 4

Ceph: Cephalic Vein, Sub: Subclavian Vein, BC: brachiocephalic Vein

Lesion Location

Our Experience – Renji Hospital

Technique

One Access: Upper arm vein punctureOR Femoral vein puncture

10

Dual Access: Upper arm vein + Femoral vein puncture

21

Our Experience – Renji Hospital

Results

Technique Success 27/31 (87.1%)

Only PTA 12/27 (44.4%)

BMS 15/27 (55.6%)

Length of Stent(mm) 86（60-130）

Symptoms Relief 27/27 (100%)

Complications 0

4 failed cases: 2 involved SVC, 1 Sub+BC long lesion

1 ipsilateral pacemaker

• Medications

Anticoagulant during angioplasty

Antiplatelet (Plavix 75mg/D) for all life

Our Experience – Renji Hospital

Our Experience – Renji Hospital

Follow-up

Period (M) 4-42M

Follow-up rate 25/27(92.6%)

• 3 died with AV access patent

• 1 case Redo with cover stent

Our Experience – Renji Hospital

Primary Patency Secondary Patency

PTA PTA+Stent PTA PTA+Stent

3M 62.5% 91.7%

6M 40.5% 60.8% 71.2% 88.8%

12M 0 0 47.5% 76.7%

24M 0 0 30.5% 65.1%

• Time of re-intervention(M): 5.8 (0.5-12)

Conclusions

• CVS is a critical problem for HD

• Stents (cover stents) may need in difficult cases

• Restenosis is popular after treatment

• Appropriate follow-up & Re-intervention is

important and effective

Better Endo, Better Access