Interventional nephrology - five years dealing with central stenosis: immediate and long-term results

• Autor(a) principal: Pinto,Helena
• Data de Publicação: 2018
• Outros Autores: Ferreira,Emanuel, Afonso,Nuno, Teixeira,Catarina, Costa,Fátima, Alves,Rui
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692018000300003
• topic: Arteriovenous Shunt; Surgical; Constriction; Pathologic; Renal Dialysis; Treatment Outcome; Vascular Patency

Introduction: Improved technique and materials have allowed us to prolong the life of hemodialysis vascular access using percutaneous transluminal balloon angioplasty (PTA). Central vein stenosis (CVS) can lead to arteriovenous access dysfunction or thrombosis. Our goal was to revise the outcomes of our institution, evaluating the immediate and long-term results in the endovascular treatment of CVS. Methods: We reviewed the data of all procedures performed in our center, Centro Hospitalar e Universitário de Coimbra, during a five-year period July 2009 and June 2014, selecting the cases that had a CVS diagnosis. We evaluated the immediate result and the existence of complications during the procedure. Long-term evaluation of PTA results of the 26 patients with a successful PTA was made through contact with the referring hospital or hemodialysis clinic. Primary and assisted access patencies were verified retrospectively at 3, 6, 12 and 24 months post-intervention. Results: Of the 31 patients in whom there were an intention to treat, in 5 the stenosis was in fact an occlusion and the guide wire could not be passed. The remaining 26 patients underwent PTA with improvement/resolution of the lesion. Consequently, we had an initial intervention success rate of 83.9%. Minor complications occurred in 2 patients. The long-term follow-up results were primary patency at 3, 6, 12 or 24 months of 88%, 63%, 31% and 6%, respectively, and assisted primary patency at 3, 6, 12 or 24 months of 88%, 76%, 70% and 46%, respectively. Conclusion: CVS is a common problem in hemodialysis patients. Our center results are consistent with current literature and demonstrate the benefit of PTA with excellent immediate success. However, the high recurrence rate of these stenoses requires in many cases multiple PTA, with low long-term primary patency.