Early Outcomes of Endovascular Treatment for Symptomatic Central Venous Stenosis or Occlusion in Maintenance Hemodialysis Patients: A Retrospective Observational Study

Abstract

Background: Central venous stenosis or occlusion is an important vascular access-related complication in patients receiving maintenance hemodialysis. It can cause venous hypertension, upper limb symptoms, and arteriovenous access dysfunction. Objectives: This study aimed to describe the clinical and imaging characteristics and to evaluate immediate anatomical success, 1-month clinical outcomes, and early complications after endovascular treatment for central venous stenosis or occlusion. Methods: This retrospective observational analysis was conducted as part of a larger longitudinal project at Cho Ray Hospital, Vietnam. Patients who underwent endovascular intervention between January 2018 and December 2025 were reviewed. Anatomical success was assessed on completion angiography, and clinical outcomes were assessed within 1 month after the intervention. Data were analyzed descriptively, with exploratory univariable analyses of anatomical failure. Results: Of 106 patients screened, 101 were included in the final analysis. The mean age was 54.97 ± 14.59 years, and 56 patients (55.4%) were female. The most common symptoms were arm edema in 78 patients (77.2%) and arm pain in 68 patients (67.3%). On angiography, the brachiocephalic and subclavian veins were involved in 60 patients (59.4%) and 50 patients (49.5%), respectively. Balloon angioplasty alone was performed in 81 of 94 patients (86.2%). Anatomical success was achieved in 91 patients (90.1%). At 1 month, arm edema decreased in 68 of 78 patients (87.2%), arm pain decreased in 54 of 68 patients (79.4%), and collateral veins decreased in 16 of 26 patients (61.5%). Hemodialysis via the treated access was achieved in 74 patients (73.3%). No early complications were recorded in 92 patients (91.1%). In univariable analysis, longer lesion length was associated with anatomic failure. Conclusions: Endovascular treatment achieved immediate anatomical success in most patients and was followed by clinical improvement within 1 month in this selected cohort. Further follow-up is needed to evaluate restenosis, reintervention, and long-term patency.