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Central Vein Stenosis

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Interventional Nephrology

Abstract

Central venous stenosis (CVS) is a relatively common problem in the hemodialysis patients and results in significant morbidity. It is often clinically apparent in those with functioning hemodialysis access, either as an autogenous arteriovenous (AV) fistula or an AV graft that is not a normal physiologic situation. The likely cause of CVS is the development of venous intimal hyperplasia from chronic trauma caused by repeated catheterization for interval access. Furthermore, the high turbulent flow from an existing AV access may potentiate development of the stenosis. The most common manifestations of central venous stenosis are ipsilateral arm or neck swelling, elevation of the venous pressure during hemodialysis, and hemodialysis access failure. CVS is frustrating to deal with, both for patients and providers alike.

The optimal treatment for central venous stenosis is yet to be determined. Endovascular techniques are presumed to be the first-line therapy, whereas open procedures are reserved for when percutaneous modalities fail. However, neither approach has gained superiority due to poor outcomes as compared to results achieved in arterial circulation. In 2006, the National Kidney Foundation (NKF) Disease Outcomes Initiative (KDOQI) guidelines recommended percutaneous transluminal angioplasty (PTA), with or without stent placement, as the preferred intervention. Recent studies using covered stents have shown some enthusiasm with increase in patency rates over PTA and bare-metal stents (BMS). Several surgical approaches have been used to maximize the limited availability of access sites and relieve symptoms. However, this requires general anesthesia and has a high surgical morbidity in ESRD population. Moreover, such surgical expertise is available at far and few centers, thereby prohibiting access to majority of patients with CVS.

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  1. LMC Diabetes and Endocrinology, 2130 North Park Dr, Brampton, ON, Canada

    Davinder Wadehra MD, MBBS

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  1. Davinder Wadehra MD, MBBS
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  1. Department of Medicine (CHS), Division of Nephrology, Madison, Wisconsin, USA

    Alexander S. Yevzlin

  2. Medicine, Nephrology and Hypertension, Albany Medical College, Albany, New York, USA

    Arif Asif

  3. Interventional Nephrology Nephrology and Hypertension, University of Miami Miller School of Med, Miami, Florida, USA

    Loay Salman

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Wadehra, D. (2014). Central Vein Stenosis. In: Yevzlin, A., Asif, A., Salman, L. (eds) Interventional Nephrology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8803-3_18

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