Clinical outcome of percutaneous angioplasty and covered stent placement for treatment of left brachiocephalic vein obstruction in hemodialysis patients.

ABSTRACT

BACKGROUND: Left brachiocephalic vein (LBV) obstruction is a common complication in patients undergoing hemodialysis. This study aimed to compare the clinical characteristics and outcomes of patients with LBV obstruction who underwent percutaneous angioplasty or stenting. METHODS: We performed a retrospective study of 67 hemodialysis patients with LBV stenosis or occlusion who underwent percutaneous transluminal angioplasty (PTA; n = 25) or percutaneous transluminal stenting (PTS; n = 42). We compared the clinical characteristics, lesion features, and patency between the two groups of patients. RESULTS: The average age, sex, smoking history, body mass index, obstruction period, comorbidities, and clinical manifestations were comparable between the PTA and PTS groups. Prior ipsilateral catheterization was less common in the PTS group than in the PTA group (14.3% vs 36.0%, p < 0.05). Smaller sized balloons were used in the PTS group than in the PTA group (p < 0.05). The overall primary patency rates were similar between the two groups, whereas the secondary patency rate in the PTS group was higher than that in the PTA group (p < 0.05). The average age, sex, smoking history, body mass index, obstruction period, prior ipsilateral catheterization, comorbidities, and types of lesions were comparable between patients with or without restenosis, while patients with restenosis had a higher percentage of high venous pressure than those without restenosis (87.5% vs 60.5%, p < 0.05). CONCLUSION: The primary patency rates were similar in the angioplasty and the stenting groups. Stenting has a significantly higher secondary patency rate than angioplasty alone for treating LBV obstruction and is required more commonly in patients without prior ipsilateral catheterization.