Percutaneous Transluminal Angioplasty in Chronic Total Subclavian Venous Stenosis Using Coronary Guidewire: A Case Report

Abstract

Arteriovenous fistula is the best permanent vascular access for hemodialysis (HD). However, in our country, HD catheter in jugular or subclavian vein is more commonly found because our patients prefer to hold HD until the complications are unbearable. The catheter increases risk of venous stenosis on site and in surrounding vessels, resulting in access loss. Percutaneous transluminal angioplasty (PTA), combined with stent deployment, can be utilized as main treatment for such stenosis in subclavian vein. This method dated back to two decades ago with high success rate. Nevertheless, reports or studies of angioplasty in total occlusion are scarce, mainly because of lower success rate and the need of smaller penetrating wire. We describe our experience in performing PTA and stent deployment using coronary wire to penetrate total occlusion in subclavian venous stenosis after vein cannulation. We hope that we can give an alternative technique to avoid surgery in such cases.

Keywords

angioplasty - arteriovenous fistula - coronary guidewire - subclavian vein - total occlusion

Publication History

Article published online:
22 November 2021

• References

• 1 Tatapudi VS, Spinowitz N, Goldfarb DS. Symptomatic central venous stenosis in a hemodialysis patient leading to loss of arteriovenous access: a case report and literature review. Nephron Extra 2014; 4 (01) 50-54
• 2 Cury MVM, Matielo MF, Calixtro AC, Sandri GA, Godoy MR, Sacilotto R. Subclavian vein angioplasty during arteriovenous fistula surgery: case report and literature review. Jornal Vascular Brasileiro 2012; 11 (02) 154-157
• 3 Schwab SJ, Beathard G. The hemodialysis catheter conundrum: hate living with them, but can't live without them. Kidney Int 1999; 56 (01) 1-17
• 4 Davis D, Petersen J, Feldman R, Cho C, Stevick CA. Subclavian venous stenosis. A complication of subclavian dialysis. JAMA 1984; 252 (24) 3404-3406
• 5 Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int 1988; 33 (06) 1156-1159
• 6 Shi YX, Ye M, Liang W, Zhang H, Zhao YP, Zhang JW. Endovascular treatment of central venous stenosis and obstruction in hemodialysis patients. Chin Med J (Engl) 2013; 126 (03) 426-430
• 7 Chang CJ, Ko PJ, Hsu LA. et al. Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis. Am J Kidney Dis 2004; 43 (01) 74-84
• 8 Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg 2007; 45 (04) 776-783
• 9 Henry JC, Sachdev U, Hager E, Dillavou E, Yuo T, Makaroun M. et al. Cephalic vein transposition is a durable approach to managing cephalic arch stenosis. J Vasc Access 2017;
• 10 Nael K, Kee ST, Solomon H, Katz SG. Endovascular management of central thoracic veno-occlusive diseases in hemodialysis patients: a single institutional experience in 69 consecutive patients. J Vasc Interv Radiol 2009; 20 (01) 46-51