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A systematic review of venoplasty versus stenting for the treatment of central vein obstruction in ipsilateral haemodialysis access.
OBJECTIVE: This review examines the evidence regarding treatment of central vein obstruction (CVO) in the setting of ipsilateral haemodialysis access. The aim is to identify whether long-term venous patency following central vein stenting is superior compared to balloon venoplasty. To date, there are no evidence-based guidelines to direct management of CVO in the setting of ipsilateral haemodialysis access.
METHODS: An extensive systematic database search was performed using Medline, Embase and Cochrane Databases to identify all articles published since January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral haemodialysis access fistulae/grafts.
RESULTS: 655 patients with 456 stenoses and 208 occlusions were treated. 288 underwent venoplasty and 345 underwent stenting. 22 patients failed intervention due to inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency is noted in those treated with stenting compared to venoplasty in the first two years. Overall, both treatments are suboptimal demonstrating a 12-month primary patency rate <60%. Assisted primary patency and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8 - 91.6% for venoplasty and 89.6 - 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients.
CONCLUSION: Although both treatments demonstrated poor patency rates, higher primary patency is noted for stenting in the first two years. Coupled with low complication rates, this highlights a potential benefit of stenting as first line treatment for CVO. Allowing for overall poor quality of current studies, even this short-term improvement in primary patency may benefit haemodialysis patients. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug coated stents/balloons, anticoagulant therapy and the role of intravascular ultrasound use is required.
METHODS: An extensive systematic database search was performed using Medline, Embase and Cochrane Databases to identify all articles published since January 2000 to November 2019 comparing the management of CVO with venoplasty and/or stenting in the setting of ipsilateral haemodialysis access fistulae/grafts.
RESULTS: 655 patients with 456 stenoses and 208 occlusions were treated. 288 underwent venoplasty and 345 underwent stenting. 22 patients failed intervention due to inability to traverse the occlusion. The most affected vein was the brachiocephalic vein. A superior primary patency is noted in those treated with stenting compared to venoplasty in the first two years. Overall, both treatments are suboptimal demonstrating a 12-month primary patency rate <60%. Assisted primary patency and secondary patency rates were similar for both venoplasty and stenting with a 12-month secondary patency rate of 77.8 - 91.6% for venoplasty and 89.6 - 98.4% for stenting. Periprocedural and long-term complications were rare for both interventions, occurring in 2% of patients.
CONCLUSION: Although both treatments demonstrated poor patency rates, higher primary patency is noted for stenting in the first two years. Coupled with low complication rates, this highlights a potential benefit of stenting as first line treatment for CVO. Allowing for overall poor quality of current studies, even this short-term improvement in primary patency may benefit haemodialysis patients. Further research with randomised control trials as well as assessment of adjuvant techniques such as drug coated stents/balloons, anticoagulant therapy and the role of intravascular ultrasound use is required.
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