الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
- Central venous stenosis and obstruction / occlusion (CVD) is a serious and prevalent complication in patients undergoing hemodialysis, where it is estimated that up to 50% of access failure is due to venous outflow stenosis.
- The ideal management target of AVFs is to preserve patency of the access rather than creating a new one, since the life expectancy of ESRD patients has increased in recent years due to better medical care and dialysis machines.
- The use of central venous catheters is the main cause of CVD, which is more commonly encountered with subclavian vein placed catheters, compared to those placed in the internal jugular vein.
- A diagnosis of CVD is based on a constellation of clinical and imaging studies, as well as measurements taken from dialysis machines during dialysis sessions, with Doppler U/S remaining the most useful imaging tool in diagnosing CVD.
- Treatment of CVD consists of two broad categories, namely: (i) endovascular intervention (PTA), with balloon dilatation of stenotic segments (with or without the use of stents); and (ii) surgical treatment with various techniques bypassing the stenotic segment, either with native veins or synthetic grafts.
- Central venous thrombosis is managed with multiple techniques of which simple thrombectomy using fogarty catheters shows satisfactory results.
- In our study we initially directed the patients to endovascular management (PTA), except for cases showing segments of complete obstruction in central veins, which were directed to surgical treatment from the start.
- PTA is now the mainstay of CVD treatment, reaching promising results of 60-80% patency rates, however repeated interventions are often needed to achieve a favorable outcome.