Dialysis circuit angiogram delineating the jump graft placed between the left cephalic and internal jugular veins. A short segment of graft-cephalic venous anastomosis stenosis is present.
Left: Pre-intervention angiogram revealing brachiocephalic occlusion and prominent surrounding venous collaterals. Right: Post-angioplasty demonstrating brachiocephalic recanalization, improved flow and resolution of surrounding venous collaterals.
arteriovenous fistula (AVF) the high flow rates increase the risk of venous hypertension.5–6
Often patients with
CVS do not require treatment unless they are symptomatic with significant arm swelling, SVC syndrome, or have poor functioning AVF and dialysis access as a result.
Main therapeutic options in these patients include venoplasty ± stenting, lead extraction with venoplasty ±
stenting, contralateral implantation of new CIED or placement of a “leadless pacemaker.”2
In a multicenter study,
27 patients with pacemaker lead- associated CVS, ipsilateral hemodialysis (HD) access and symptomatic swelling were treated with conventional balloon angioplasty with a 100% clinical success rate. Primary patency at 6 and 12 months was 18% and 9% respectively. Secondary patency defined as patency until access was revised
or abandoned was 95%, 86% and 73% at 6, 12 and 24 months, respectively. A mean of 2.1 procedures⁄year were required to maintain secondary patency and no procedural complications were encountered.8
A study of 14
dialysis patients with ipsilateral HD arteriovenous (AV) access who had symptomatic central venous stenosis or occlusion were treated with angioplasty and stenting to evaluate patency rates and complications with
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