Endovascular Management of Thoracic Central Venous Obstruction with Symptomatic Venous Hypertension in Hemodialysis Patients

Document Type : Original Article

Authors

Vascular Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446525

Abstract

Background: Vascular access is essential for a hemodialysis patient. The prevalence of end-stage renal disease (ESRD) patients is rising significantly on a global scale.
Aim: To evaluate the feasibility and clinical success of endovascular management for symptomatic central venous obstruction in end-stage renal disease patients undergoing regular hemodialysis. The primary goal is to maintain hemodialysis access site patency and improve symptomatic outcomes.
Methods: This was a prospective, randomized clinical study performed at the Vascular and Endovascular Surgery Departments in Al-Azhar University Hospital, Egypt, and Damanhour Medical National Institute, Egypt, on 60 patients with chronic kidney disease who underwent regular dialysis. The research study continued for two years, from February 2023 to March 2025.
Results: (85%) of the studied group were primary improvement, (15%) were failed cases, (20%) were reintervention by stenting, and (5%) were complicated cases. At 3 months (100%) of the studied group were patent, at 6 months (94%) of the studied group were patent, (5%) were re-occluded, (5%) were need ligation, and at 12 months (88%) of the studied group were patent, 11.7%) were re-occluded, 7.8% were need ligation, and 3%) were need ligation.
Conclusion: Preoperative ipsilateral subclavian vein hemodynamic catheters can cause venous stenosis and hypertension. Instead, internal jugular vein catheters are recommended. Diagnostic tools include venous duplex ultrasound and digital subtraction venography.

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