A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access
This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are...
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Published in | Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 9; no. 5; pp. 1302 - 1311 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.09.2021
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Abstract | This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access.
An extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts.
There were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients.
Although both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required. |
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AbstractList | This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access.
An extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts.
There were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients.
Although both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required. OBJECTIVEThis review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work is to identify whether long-term venous patency after central vein stenting is superior compared with balloon venoplasty. To date, there are no evidence-based guidelines to direct the management of CVO in the setting of ipsilateral hemodialysis access. METHODSAn extensive systematic database search was performed using Medline, Embase, and the Cochrane Databases to identify all articles published from January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral hemodialysis access fistulae/grafts. RESULTSThere were 655 patients with 456 stenoses and 208 occlusions who were treated; 288 underwent venoplasty and 345 underwent stenting. Twenty-two patients failed intervention owing to an inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency (PP) is noted in those treated with stenting compared with venoplasty in the first 2 years. Overall, both treatments are suboptimal demonstrating a 12-month PP rate of less than 60%. Assisted PP and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8% to 91.6% for venoplasty and 89.6% to 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients. CONCLUSIONSAlthough both treatments demonstrated poor patency rates, greater PP is noted for stenting in the first 2 years. Coupled with low complication rates, this finding highlights a potential benefit of stenting as a first-line treatment for CVO. Allowing for the overall poor quality of current studies, even this short-term improvement in PP may benefit patients undergoing hemodialysis. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug-coated stents and balloons, anticoagulant therapy, and the role of intravascular ultrasound use is required. |
Author | Andrawos, Alice Delaney, Christopher Saeed, Hani |
Author_xml | – sequence: 1 givenname: Alice surname: Andrawos fullname: Andrawos, Alice email: aliceandrawos@gmail.com organization: Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia – sequence: 2 givenname: Hani surname: Saeed fullname: Saeed, Hani organization: Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia – sequence: 3 givenname: Christopher surname: Delaney fullname: Delaney, Christopher organization: Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Bedford Park, Australia |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33667742$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_3389_fcvm_2022_901237 crossref_primary_10_1177_11297298231193893 crossref_primary_10_1590_1677_5449_210130 crossref_primary_10_1016_j_jvsv_2023_01_012 crossref_primary_10_1177_11297298221095320 crossref_primary_10_1007_s00270_023_03461_7 crossref_primary_10_3389_fcvm_2022_954443 |
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Keywords | Occlusion Arteriovenous fistula Hemodialysis Angioplasty Venous stenosis Renal replacement therapy Venoplasty Stent |
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Snippet | This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of this work... OBJECTIVEThis review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral hemodialysis access. The aim of... |
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SubjectTerms | Angioplasty Arteriovenous fistula Arteriovenous Shunt, Surgical - adverse effects Endovascular Procedures Graft Occlusion, Vascular - etiology Hemodialysis Humans Occlusion Renal Dialysis Renal replacement therapy Stent Stents Vascular Patency Venoplasty Venous stenosis |
Title | A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral hemodialysis access |
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