Vascular Access Stenosis and Central Vein Obstruction
Interventions: Five Years of Experience in
Ramathibodi Hospital
Jiemjit Tapaneeyakorn MD*,
Thanipa Inman MD*, Tanapong Panpikul MD*,
Banjongsak Wedsart MD*, Jesada Suvikrom MD*
Affiliation :
* Division of Body Intervention, Department of Radiology, Ramathibodi Hospital, Mahidol University Bangkok, Thailand
Objective : To evaluate initial post-treatment and six months outcome of patients sent to the intervention radiology unit with
vascular access malfunctions.
Material and Method: A retrospective study of venoplasty, venoplasty with stenting, and venoplasty with thrombolysis for
vascular access failure patients, included 53 patients with 67 interventional radiology procedures at the intervention
radiology unit of Ramathibodi Hospital between January 2004 and June 2009.
Results : Sixty-seven intervention procedures were performed in 53 patients. Two patients had severe stenosis of AVF
anastomosis with a resulting in failure to perform venoplasty. There were 34 lesions of central venous obstruction. The
lesions were usually short and 79% shorter than 4.0 cm. In the group of central venous obstruction that performed venoplasty
alone, the degree of stenosis was 58.7 18.6% (mean SD) with 69.2% technical success and 84.6% clinical successes.
However, the technical success was increased to 71.4% and clinical success was increased to 100% in the stent placement
group. At the six-month follow-up, there was no significant clinical re-obstruction. Fair to good outcomes of interventional
procedures of vascular access and peripheral venous stenosis were achieved. Within the group of 14 lesions of patients who
underwent AVBG, the degree of stenosis was 64.4 14.4% with 57.1% technical success and 100% clinical successes. In
the other group of 19 lesions that underwent native AVF, the degree of stenosis was 61 9.4% with 52.6% technical success
and 89% clinical successes. Two patients had re-stenosis and thrombosis in AVBG six months after treatment procedure.
Conclusion : Percutaneous interventional radiology procedure continues to play a beneficial role in treatment, and remains
the first treatment of choice in vascular access malfunction and corollary complications of central venous obstruction. The
technical success rate of treatments is determined by morphologic features of each lesion, with the identification of these
features helping in proper planning and the use of appropriate instruments.
Keywords : Interventional radiology, Vascular access stenosis, Central venous obstruction, Venoplasty, Stenting, Thrombolysis
All Articles
Download