Hemodialysis Shunts-related Subclavian Vein Stenosis: Treatment with Self-expandable Metallic Stent

Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Sujinna

Abstract

PURPOSE: To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-relatedsubclavian vein stenosis.
MATERIALS AND METHODS
Self-expandable metallic stent was placed in nine patients withhemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stentplacement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis afterangioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and themeasurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5months and 1 year 7 months. Repeated intervention was performed if restenosis was detected.
RESULTS
The stenoticsites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomicnarrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%; a resultingcomplication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this wasremoved by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosisdeveloped in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases weretreated by balloon dilatation.
CONCLUSION
In hemodialytic shunt-related subclavian vein stenosis, treatmentinvolving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has notresponded to angioplasty with a high patency rate.