Medicina Interna: Acesso Aberto
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Should Endovascular Intervention be the First Choice to Treat Central Vein Stenosis in Hemodialysis Population?

Xiao-Mei Huang, Tao HE, Cheng-Nian HE, Wen-Li Chen, Bi-Hui QU, Xiao-Ming Liu, Hong-Ying Hua and Chang-Xuan Liu

Purpose: To evaluate the clinical features and the survival benefits of Chinese hemodialysis (HD) patients with central vein stenosis (CVS) undergoing different treatments.

Methods: From January 1, 2011 to Dec 31, 2012, 116 HD patients at high risk of CVS at our hospital had their bilateral central veins assessed by vascular ultrasound and conventional venography. We compared the clinical outcome of 24 non-treated asymptomatic, 17 non-treated symptomatic CVS and 6 treated symptomatic CVS. Treatment costs of CVS were recorded and patients’ survival rates were estimated by Kaplan-Meier analysis.

Results: Among 116 patients, 47 were diagnosed with CVS. The timespan between symptomatic presentation and the diagnosis of CVS was more than 10 months averagely. Compared with non-CVS patients, the duration of HD in CVS patients was longer (33.8 ± 14.5 vs 1.1 ± 0.7 months) and the rate of central venous catheter (CVC) insertion was higher (87.2% vs 14.5%). Only 6 patients tried to maintain vascular access by endovascular intervention, the cost for which was $5210 per person, much higher than other treatment options. While 30 patients refused endovascular intervention for fear of re-stenosis risk and high treatment costs, among whom 28 lost their initial vascular access. The 12-month survival rates were 87.8%, 60% and 80.3%, respectively. The 24-month survival rates were 48.8%, 60% and 42.8%, respectively. No significant difference was found among the three groups.

Conclusions: Endovascular intervention may not be the first choice for HD patients with CVS, considering long term survival benefit and high treatment cost.