Semin intervent Radiol 2009; 26(2): 115-121
DOI: 10.1055/s-0029-1222454
© Thieme Medical Publishers

Central Venous Obstruction Management

Sanjoy Kundu1
  • 1Department of Medical Imaging, Scarborough Hospital, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
29 June 2009 (online)


A major challenge in the management of hemodialysis patients is central venous stenosis and obstruction. Placement of central venous catheters has been shown to result in a high incidence of central venous stenosis or obstruction. There has been extensive literature on the treatment of this important and prevalent problem. Treatment options include percutaneous balloon angioplasty and bare metal stents. Unfortunately, all the available treatment options have variable rates of patency, requiring repeated intervention. More recently, covered stents have been mentioned in the literature for the treatment of central venous stenosis and obstruction. There is very little data to date, and further randomized controlled trials will be needed to compare the efficacy of percutaneous balloon angioplasty, bare metal stents, and covered stents. It appears prevention of this difficult problem is paramount, by limiting use of central venous catheters.


  • 1 Lumsden A B, MacDonald M J, Isiklar H et al.. Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment.  Cardiovasc Surg. 1997;  5(5) 504-509
  • 2 Glanz S, Gordon D H, Lipkowitz G S, Butt K M, Hong J, Sclafani S J. Axillary and subclavian vein stenosis: percutaneous angioplasty.  Radiology. 1988;  168(2) 371-373
  • 3 Agarwal A K, Patel B M, Farhan N J. Central venous stenosis in hemodialysis patients is a common complication of ipsilateral central vein catheterization.  J Am Soc Nephrol. 2004;  15 368A-369A
  • 4 Barrett N, Spencer S, McIvor J, Brown E A. Subclavian stenosis: a major complication of subclavian dialysis catheters.  Nephrol Dial Transplant. 1988;  3(4) 423-425
  • 5 Cimochowski G E, Worley E, Rutherford W E, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis.  Nephron. 1990;  54(2) 154-161
  • 6 Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses.  Nephrol Dial Transplant. 1991;  6(10) 722-724
  • 7 Vanherweghem J L, Yassine T, Goldman M et al.. Subclavian vein thrombosis: a frequent complication of subclavian vein cannulation for hemodialysis.  Clin Nephrol. 1986;  26(5) 235-238
  • 8 Palabrica T, Lobb R, Furie B C et al.. Leukocyte accumulation promoting fibrin deposition is mediated in vivo by P-selectin on adherent platelets.  Nature. 1992;  359(6398) 848-851
  • 9 Weiss M F, Scivittaro V, Anderson J M. Oxidative stress and increased expression of growth factors in lesions of failed hemodialysis access.  Am J Kidney Dis. 2001;  37(5) 970-980
  • 10 Fillinger M F, Reinitz E R, Schwartz R A et al.. Graft geometry and venous intimal-medial hyperplasia in arteriovenous loop grafts.  J Vasc Surg. 1990;  11(4) 556-566
  • 11 Middleton W D, Erickson S, Melson G L. Perivascular color artifact: pathologic significance and appearance on color Doppler US images.  Radiology. 1989;  171(3) 647-652
  • 12 MacRae J M, Ahmed A, Johnson N et al.. Central vein stenosis: a common problem in patients on hemodialysis.  ASAIO J. 2005;  51 77-81
  • 13 Schon D, Whittman D. Managing the complications of long-term tunneled dialysis catheters.  Semin Dial. 2003;  16(4) 314-322
  • 14 Moss A H, Vasilakis C, Holley J L, Foulks C J, Pillai K, McDowell D E. Use of a silicone dual-lumen catheter with a Dacron cuff as a long-term vascular access for hemodialysis patients.  Am J Kidney Dis. 1990;  16(3) 211-215
  • 15 Salgado O J, Urdaneta B, Colmenares B, García R, Flores C. Right versus left internal jugular vein catheterization for hemodialysis: complications and impact on ipsilateral access creation.  Artif Organs. 2004;  28(8) 728-733
  • 16 Gonsalves C F, Eschelman D J, Sullivan K L, DuBois N, Bonn J. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement.  Cardiovasc Intervent Radiol. 2003;  26(2) 123-127
  • 17 Trerotola S O, Kuhn-Fulton J, Johnson M S, Shah H, Ambrosius W T, Kneebone P H. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access.  Radiology. 2000;  217(1) 89-93
  • 18 Beathard G A. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis.  Kidney Int. 1992;  42(6) 1390-1397
  • 19 Korzets A, Chagnac A, Ori Y, Katz M, Zevin D. Subclavian vein stenosis, permanent cardiac pacemakers and the haemodialysed patient.  Nephron. 1991;  58(1) 103-105
  • 20 Chuang C L, Tarng D C, Yang W C, Huang T P. An occult cause of arteriovenous access failure: central vein stenosis from permanent pacemaker wire. Report of three cases and review of the literature.  Am J Nephrol. 2001;  21(5) 406-409
  • 21 Sticherling C, Chough S P, Baker R L et al.. Prevalence of central venous occlusion in patients with chronic defibrillator leads.  Am Heart J. 2001;  141(5) 813-816
  • 22 Schwab S J, Quarles L D, Middleton J P, Cohan R H, Saeed M, Dennis V W. Hemodialysis-associated subclavian vein stenosis.  Kidney Int. 1988;  33(6) 1156-1159
  • 23 Clark D D, Albina J E, Chazan J A. Subclavian vein stenosis and thrombosis: a potential serious complication in chronic hemodialysis patients.  Am J Kidney Dis. 1990;  15(3) 265-268
  • 24 Nakhoul F, Hashmonai M, Angel A, Bahous H, Green J. Extreme swelling of a limb with A-V shunt for hemodialysis resulting from subclavian vein thrombosis due to previous catheterization.  Clin Nephrol. 1998;  49(2) 134-136
  • 25 Gadallah M F, El-Shahawy M A, Campese V M. Unilateral breast enlargement secondary to hemodilaysis arterivenous fistula and subclavian vein occlusion.  Nephron. 1993;  63 351-353
  • 26 Wright R S, Quinones-Baldrich W J, Anders A J, Danovitch G M. Pleural effusion associated with ipsilateral breast and arm edema as a complication of subclavian vein catheterization and arteriovenous fistula formation for hemodialysis.  Chest. 1994;  106(3) 950-952
  • 27 Baker G L, Barnes H J. Superior vena cava syndrome: etiology, diagnosis, and treatment.  Am J Crit Care. 1992;  1(1) 54-64
  • 28 Khanna S, Sniderman K, Simons M et al.. Superior vena cava stenosis associated with hemodialysis catheters.  Am J Kidney Dis. 1993;  21 278-281
  • 29 Rose S C, Kinney T B, Bundens W P, Valji K, Roberts A C. Importance of Doppler analysis of transmitted atrial waveforms prior to placement of central venous access catheters.  J Vasc Interv Radiol. 1998;  9(6) 927-934
  • 30 Marckmann P, Skov L, Rossen K et al.. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging.  J Am Soc Nephrol. 2006;  17(9) 2359-2362
  • 31 NKF-K/DOQUI clinical practice guidelines for vascular access: Update 2000.  Am J Kidney Dis. 2001;  37 S137-S181
  • 32 Glanz S, Gordon D, Butt K MH, Hong J, Adamson R, Sclafani S J. Dialysis access fistulas: treatment of stenoses by transluminal angioplasty.  Radiology. 1984;  152(3) 637-642
  • 33 Trerotola S O, McLean G K, Burke D R et al.. Treatment of subclavian venous stenoses by percutaneous transluminal angioplasty.  J Vasc Interv Radiol. 1986;  1 15-18
  • 34 Kovalik E C, Newman G E, Suhocki P, Knelson M, Schwab S J. Correction of central venous stenoses: use of angioplasty and vascular Wallstents.  Kidney Int. 1994;  45(4) 1177-1181
  • 35 Quinn S F, Schuman E S, Demlow T A et al.. Percutaneous transluminal angioplasty versus endovascular stent placement in the treatment of venous stenoses in patients undergoing hemodialysis: intermediate results.  J Vasc Interv Radiol. 1995;  5 851-855
  • 36 Dammers R, de Haan M W, Planken N R, van der Sande F M, Tordoir J H. Central vein obstruction in hemodialysis patients: results of radiological and surgical intervention.  Eur J Vasc Endovasc Surg. 2003;  26(3) 317-321
  • 37 Surowiec S M, Fegley A J, Tanski W J et al.. Endovascular management of central venous stenoses in the hemodialysis patient: results of percutaneous therapy.  Vasc Endovascular Surg. 2004;  38(4) 349-354
  • 38 Bakken A M, Protack C D, Saad W E, Lee D E, Waldman D L, Davies M G. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients.  J Vasc Surg. 2007;  45(4) 776-783
  • 39 Günther R W, Vorwerk D, Bohndorf K et al.. Venous stenoses in dialysis shunts: treatment with self-expanding metallic stents.  Radiology. 1989;  170(2) 401-405
  • 40 United States Renal Data System .USRD 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD; National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases 2003
  • 41 Aruny J E, Lewis C A, Cardella J F et al.. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. Standards of Practise Committee of the Society of Cardiovascular & Interventional Radiology.  J Vasc Interv Radiol. 2003;  14 S247-S253
  • 42 NKF-DOQI clinical practice guidelines for vascular access. National Kidney Foundation-Dialysis Outcomes Quality Initiative.  Am J Kidney Dis. 1997;  30(Suppl 3) S150-S191
  • 43 Clark T WI. Nitinol stents in hemodialysis access.  J Vasc Interv Radiol. 2004;  15(10) 1037-1040
  • 44 Flueckiger F, Sternthal H, Klein G E, Aschauer M, Szolar D, Kleinhappl G. Strength, elasticity, and plasticity of expandable metal stents: in vitro studies with three types of stress.  J Vasc Interv Radiol. 1994;  5(5) 745-750
  • 45 Rogers C, Edelman E R. Endovascular stent design dictates experimental restenosis and thrombosis.  Circulation. 1995;  91(12) 2995-3001
  • 46 Trerotola S O, Fair J H, Davidson D, Samphilipo Jr M A, Magee C A. Comparison of Gianturco Z stents and Wallstents in a hemodialysis access graft animal model.  J Vasc Interv Radiol. 1995;  6(3) 387-396
  • 47 Dyet J F, Watts W G, Ettles D F, Nicholson A A. Mechanical properties of metallic stents: how do these properties influence the choice of stent for specific lesions?.  Cardiovasc Intervent Radiol. 2000;  23(1) 47-54
  • 48 Verstandig A G, Bloom A I, Sasson T, Haviv Y S, Rubinger D. Shortening and migration of Wallstents after stenting of central venous stenoses in hemodialysis patients.  Cardiovasc Intervent Radiol. 2003;  26(1) 58-64
  • 49 Shabalovskaya S A. On the nature of the biocompatibility and on medical applications of NiTi shape memory and superelastic alloys.  Biomed Mater Eng. 1996;  6(4) 267-289
  • 50 Duda S H, Wiskirchen J, Tepe G et al.. Physical properties of endovascular stents: an experimental comparison.  J Vasc Interv Radiol. 2000;  11(5) 645-654
  • 51 Vogel P M, Parise C P. SMART stent for salvage of hemodialysis access grafts.  J Vasc Interv Radiol. 2004;  15(10) 1051-1060
  • 52 Aytekin C, Boyvat F, Yağmurdur M C, Moray G, Haberal M. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients.  Eur J Radiol. 2004;  49(1) 81-85
  • 53 Chen C Y, Liang H L, Pan H B et al.. Metallic stenting for treatment of central venous obstruction in hemodialysis patients.  J Chin Med Assoc. 2003;  66(3) 166-172
  • 54 Oderich G S, Treiman G S, Schneider P, Bhirangi K. Stent placement for treatment of central and peripheral venous obstruction: a long-term multi-institutional experience.  J Vasc Surg. 2000;  32(4) 760-769
  • 55 Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther R W. Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary Wallstent placement and follow-up in 50 patients.  Radiology. 1999;  212(1) 175-180
  • 56 Vesely T M, Hovsepian D M, Pilgram T K, Coyne D W, Shenoy S. Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents.  Radiology. 1997;  204(2) 343-348
  • 57 Gray R J, Horton K M, Dolmatch B L et al.. Use of Wallstents for hemodialysis access-related venous stenoses and occlusions untreatable with balloon angioplasty.  Radiology. 1995;  195(2) 479-484
  • 58 Vorwerk D, Guenther R W, Mann H et al.. Venous stenosis and occlusion in hemodialysis shunts: follow-up results of stent placement in 65 patients.  Radiology. 1995;  195 140-146
  • 59 Vesely T M. Use of stent grafts to repair hemodialysis graft-related pseudoaneurysms.  J Vasc Interv Radiol. 2005;  16(10) 1301-1307
  • 60 Naoum J J, Irwin C, Hunter G C. The use of covered nitinol stents to salvage dialysis grafts after multiple failures.  Vasc Endovascular Surg. 2006;  40(4) 275-279
  • 61 Hausegger K A, Tiessenhausen K, Klimpfinger M, Raith J, Hauser H, Tauss J. Aneurysms of hemodialysis access grafts: treatment with covered stents: a report of three cases.  Cardiovasc Intervent Radiol. 1998;  21(4) 334-337
  • 62 Silas A M, Bettmann M A. Utility of covered stents for revision of aging failing synthetic hemodialysis grafts: a report of three cases.  Cardiovasc Intervent Radiol. 2003;  26(6) 550-553
  • 63 Sapoval M R, Turmel-Rodrigues L A, Raynaud A C, Bourquelot P, Rodrigue H, Gaux J C. Cragg covered stents in hemodialysis access: initial and midterm results.  J Vasc Interv Radiol. 1996;  7(3) 335-342
  • 64 Quinn S F, Kim J, Sheley R C. Transluminally placed endovascular grafts for venous lesions in patients on hemodialysis.  Cardiovasc Intervent Radiol. 2003;  26(4) 365-369
  • 65 Gradman W S, Bressman P, Sernaque J D. Subclavian vein repair in patients with an ipsilateral arteriovenous fistula.  Ann Vasc Surg. 1994;  8 549-556
  • 66 Chandler N M, Mistry B M, Garvin P J. Surgical bypass for subclavian vein occlusion in hemodialysis patients.  J Am Coll Surg. 2002;  194(4) 416-421

Sanjoy KunduB.Sc. M.D. 

217 Davenport Road, Toronto, Ontario

Canada M5R 1J3