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Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

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Abstract

Purpose

To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions.

Materials and Methods

Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50–83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14), and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria).

Results

Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9–7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4–8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14).

Conclusions

This PTFE encapsulated stent graft demonstrates encouraging intermediate-term patency results for central vein occlusions. Further prospective studies with long-term assessment and larger patient populations will be required.

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Abbreviations

HD:

Hemodialysis

PTA:

Percutaneous transluminal angioplasty

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Imaging, Scarborough General Hospital—General Division, Scarborough, ON, Canada

    Sanjoy Kundu & Milad Modabber

  2. The Vein Institute of Toronto, Toronto, ON, Canada

    Sanjoy Kundu

  3. Department of Vascular Surgery, Scarborough General Hospital—General Division, Scarborough, ON, Canada

    John M. You

  4. Department of Nephrology, Scarborough General Hospital—General Division, Scarborough, ON, Canada

    Paul Tam, Gordon Nagai & Robert Ting

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  1. Sanjoy Kundu
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  2. Milad Modabber
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Correspondence to Sanjoy Kundu.

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Kundu, S., Modabber, M., You, J.M. et al. Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results. Cardiovasc Intervent Radiol 34, 949–957 (2011). https://doi.org/10.1007/s00270-010-0019-4

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