Long-term outcomes of refractory central venous occlusive disease treated by stent deployment in patients undergoing maintenance hemodialysis.

OBJECTIVES

To investigate the long-term outcomes of stent deployment in the treatment of refractory central venous occlusive disease (CVOD) in patients undergoing maintenance hemodialysis (MHD).

METHODS

MHD patients who were successfully treated with stenting for symptomatic CVOD that was resistant to balloon angioplasty alone were consecutively included in this retrospective study. The primary (PPR) and assisted (APR) patency rates of the central vein and hemodialysis vascular access (VA), reintervention, and survival rates after stenting were followed. Multivariate logistic regression analyses were conducted to determine the factors influencing VA abandonment and mortality.

RESULTS

The cohort comprised 65 patients (52.3% male) aged 61.5 ± 13.5 years, with a mean dialysis vintage of 54.7 ± 39.1 months. During 40 (20-54) months of follow-up, symptomatic CVOD recurred in 32 (49.2%) patients, accounting for 51 secondary angioplasties, including 34 stenting procedures. The PPR and APR at 12, 24, 36, 48, and 60 months were 81%, 52%, 47%, 41%, and 41% and 98%, 98%, 82%, 82%, and 82%, respectively. VA abandonment was noted in 10 (15.4%) patients. Six (9.2%) and 17 (26.2%) patients died due to cardiovascular conditions and all causes, respectively. The number of secondary stenting procedures was significantly associated with decreased VA abandonment [odds ratio (OR) = 0.089, 95% confidence interval (CI): 0.008-0.992,  = 0.049] and all-cause mortality (OR = 0.104, 95% CI: 0.011-0.947,  = 0.045).

CONCLUSIONS

Angioplasty with stenting is an effective and promising strategy for MHD patients with refractory CVOD.