Abstract
Background and Aims
Central Venous Obstruction (CVO) is one of the major causes of morbidity in Chronic Kidney Disease (CKD) patients on maintenance Hemodialysis (HD).
The aim of the study was to assess the patterns of CVO and the role of Endovascular interventions to restore the patency of vascular access in patients on HD with CVO.
Method
We report 15 cases of CVO in HD patients between April 2015 to April 2018. Data regarding patients’ basic information, primary disease, dialysis duration, access at initiation, number and sites of central venous catheterizations, vascular segments stenosed or thrombosed, type of endovascular interventions done and outcomes were collected from electronic record system.
Results
Out of 15 cases of CVO, 11 had the first dialysis with a temporary catheter either to Internal Jugular vein or femoral vein. The average time of presentation to our hospital from initiation of dialysis was 14.8 months. 8 patients presented with symptomatic SVC obstruction. The most common site of CVO was left Brachio-cephalic vein followed by right brachio-cephalic, right subclavian and left subclavian vein. 12 patients underwent Percutaneous Transluminal Angioplasty (PTA) and 3 required bare metal stenting (BMS) along with PTA. One patient required repeat PTA after 4 months. 11 patients did not require further procedure in the mean follow up period of 110 days. PTA was found to be successful in 11 out of 12 cases. Post PTA 9 patients underwent tunneled HD catheter insertion.
Conclusion
Patients of CKD who present late to the nephrologists require HD to be initiated through temporary catheters to central veins. Repeated central venous catheterization is associated with CVO. Endovascular intervention is an effective modality for maintaining HD access patency in such cases.