Comparison of venous access strategies for endovascular management of central venous stenosis or occlusion in hemodialysis patients

Abstract:

Background and Aims Central venous stenosis or occlusion (CVSO) compromises the effectiveness of hemodialysis; however, the optimal venous access strategy remains unclear. This study compared the applicability, technical success rates, and clinical success rates of unidirectional venous access (UVA) and bidirectional venous access (BVA) in maintenance hemodialysis patients with CVSO undergoing percutaneous transluminal angioplasty (PTA) or percutaneous transluminal stenting (PTS). Stratified analyses were performed according to lesion location and type, aiming to establish individualized venous access selection criteria for different lesion subtypes.Methods A retrospective analysis was conducted on the clinical data of 63 maintenance hemodialysis patients with CVSO treated between July 2019 and February 2024 at the First Affiliated Hospital of Gannan Medical University and the Second Affiliated Hospital of Nanchang University, including 37 patients in the UVA group and 26 patients in the BVA group. Technical success (residual stenosis <30%), clinical success (symptom relief), and patency outcomes of different venous access strategies in the endovascular treatment of CVSO were compared.Results Baseline characteristics were comparable between the two groups (all P>0.05). No significant differences were observed in overall technical or clinical success rates (both P>0.05). Subgroup analysis demonstrated that the UVA group achieved a higher technical success rate in superior vena cava and brachiocephalic vein stenosis compared to the BVA group, along with a better clinical success rate specifically in brachiocephalic vein stenosis, whereas BVA was associated with significantly higher technical and clinical success rates in subclavian vein occlusion (all P<0.05). No significant differences were found in primary or secondary patency rates at 6 and 12 months (all P>0.05).Conclusion UVA is preferable for stenotic lesions of the superior vena cava and brachiocephalic vein, whereas BVA should be prioritized for subclavian vein occlusion. Tailoring venous access strategies according to lesion location and type may enhance procedural success in endovascular treatment of CVSO.