Endovascular management of vascular complications in hemodialysis patients: a single-center experience ​

Abstract

Background/aim: Vascular access failure remains a major cause of morbidity in patients undergoing hemodialysis. This study aimed to evaluate the types of endovascular interventions performed for hemodialysis-related vascular complications, as well as their technical success and patency outcomes, at a single center. Materials and methods: A total of 103 lesions in 89 patients treated between 2001 and 2023 were retrospectively analyzed. Catheterrelated complications, central venous stenosis or occlusion, and arteriovenous fistula- or graft-related complications were managed using endovascular techniques. Endovascular interventions included catheter repositioning, thrombolysis, percutaneous transluminal angioplasty (PTA), stent placement for central venous lesions, PTA of the fistula vein or feeding artery, and fistula closure. Adjunctive antiplatelet therapy was used selectively, particularly after stent placement. Primary patency rates were assessed at 6 and 12 months in patients with available follow-up data. Descriptive statistics were performed. Results: Of the lesions analyzed, 22% were catheter-related, 51% involved central venous stenosis or occlusion, and 26% were accessrelated. Technical success was achieved in 100% of catheter repositioning cases. The success rate for thrombolysis of occluded catheters was 80%. PTA for central venous lesions had an 86% success rate, while stenting had a 100% success rate. Follow-up data for patency assessment were available in 34 patients. Among patients with available follow-up data, the primary patency rates at 6 and 12 months for central venous lesions treated with PTA were 85% and 70%, respectively. When PTA was combined with stenting in these lesions, primary patency rates at 6 and 12 months were 55% and 33%, respectively. In patients with juxta-anastomotic vein stenosis of an arteriovenous fistula, PTA achieved a 6-month primary patency rate of 60%; however, 12-month follow-up data were unavailable. Fistula closure was technically successful in the single patient who required this procedure. Conclusion: In this single-center retrospective study, endovascular interventions were associated with high immediate technical success in hemodialysis patients with vascular access-related complications. However, patency outcomes should be interpreted cautiously because follow-up data were available only for a subgroup of patients. PTA and selective stent placement may represent useful minimally invasive treatment options for maintaining or restoring vascular access function.