Central Venous Stenosis and Occlusion in Dialysis Patients: A Technical and Outcome-Based Analysis of Endovascular Intervention

PURPOSE: The purpose of the study is to evaluate the early and long-term technical and clinical outcomes of endovascular treatment for central venous stenosis (CVS) and occlusion (CVO) in hemodialysis patients, and to describe procedural strategies aiming at optimizing vascular access preservation. MATERIALS AND METHODS: A retrospective single-center analysis was performed including all patients with an upper-limb arteriovenous access undergoing endovascular revascularization for symptomatic CVS/CVO between January 2020 and December 2024. Indications comprised severe venous congestion, prolonged bleeding after dialysis, poor access maturation, and inadequate dialysis efficiency. Diagnosis was established by duplex ultrasound and computed tomography angiography; digital subtraction angiography was used when noninvasive imaging was inconclusive. Procedural details, device use, and perioperative outcomes were recorded. Primary outcome was primary patency; secondary outcomes included technical success, procedural safety, cumulative (secondary) patency, and freedom from reintervention. RESULTS: Forty-four patients (mean age 65.8±16.2 years; 59.1% male) were treated, 50% for complete occlusions. The most frequent lesion site was the brachiocephalic vein (70.4%). High-pressure balloon angioplasty was performed in 93.2% of cases, and stents were implanted in 45.5% (mostly self-expanding nitinol). Technical success was achieved in 93.2% with no perioperative complications. Over a median follow-up of 36.7±32.2 months, 20 patients (45.5%) underwent reintervention for restenosis (34.1%) or reocclusion (11.4%); 30% of reinterventions revealed stent fractures. Kaplan-Meier analysis showed primary patency rates of 85.5% at 6 months, 69.9% at 12 months, and 58.7% at 18 months. Cumulative patency was 88.4% at 6 months, 80.9% at 12 and 24 months, 74.8% at 36 months, and 69.1% at 60 months. Prior ipsilateral central venous catheter placement was associated with reduced freedom from reintervention. CONCLUSIONS: Endovascular revascularization of CVS/CVO in hemodialysis patients is safe and offers high technical success. While primary patency declines over time, cumulative patency remains favorable, underscoring the role of timely reinterventions and structured surveillance in prolonging access life.Clinical ImpactThis study reinforces endovascular revascularization as a safe and effective first-line strategy for managing central venous stenosis and occlusion in hemodialysis patients, allowing immediate reuse of the vascular access and avoiding dialysis interruption. The data highlight that long-term success depends less on a single "perfect" procedure and more on structured surveillance and timely reintervention. Prior ipsilateral central venous catheter placement emerges as a key predictor of failure, underscoring the need to minimize catheter use and promote early AVF creation. From a practical standpoint, selective primary stenting in long or recoil-prone lesions and careful attention to stent durability can meaningfully prolong access lifespan in this fragile population.