Factors Affecting Outcomes of Percutaneous Transluminal Angioplasty for Central Vein Occlusive Disease in the University of the Philippines-Philippine General Hospital: A 10-Year Experience.

Abstract

Objective: To describe the treatment outcomes of patients who underwent Percutaneous Transluminal Angioplasty (PTA) for Central Vein Occlusive Disease (CVOD) in end-stage kidney disease and determine the association between patient profile and treatment outcomes.

Methods: A single-institution, retrospective review of patients aged 18 and above with end-stage kidney disease who underwent PTA for CVOD in the University of the Philippines - Philippine General Hospital (UP-PGH) from January 1, 2013, to December 31, 2022, was performed. These patients' demographic and clinical profiles were evaluated using means, frequencies, and percentages. The relationship between patient profile and success of PTA was assessed using Chi-square and Mann-Whitney U tests.

Results: One hundred one patients were included in the study. Eighty-two had a first intervention, and 19 had a recurrent first intervention. The mean age was 49.8 years, with forty-six (45.5%) males and fifty-five (54.5%) females. The most common comorbidity was hypertension (59.4%). This was followed by diabetes (35.6%), chronic glomerulonephritis (18.8%), and NSAID nephropathy (4.9%). Other comorbidities include lupus nephritis, urate nephropathy, and polycystic kidney disease. The interval between symptoms and intervention ranged from two weeks to ninety-six weeks. Eleven patients (10.9%) had an arterio-venous fistula (AVF) before initiating dialysis and did not have a history of dialysis catheter use. Temporary catheters comprise most of the central vein catheters (CVC) (84.2%), while tunneled catheters were a minority (8.9%). The overall central line insertions of one hundred one patients were one hundred fifty-five, most via the right internal jugular vein (86%). There was a total of one hundred twenty-seven lesions seen during venography. Most of these lesions were in the left Innominate vein (38.6%, 39/101) and the right innominate vein (32.7%, 33/101). The most common type of lesion was stenosis (47.5%), followed by abrupt occlusions (31.7%) and tapered occlusions (20.8%). The overall success rate of PTA was 74.2%. In the second intervention for recurrence (n=19), the success rate was 78.9% (15/19). Third-time intervention in three patients was all successful. The success rate in stenotic, tapered, and abrupt lesions were 100%, 85.7%, and 28.1%, respectively. Symptom-free intervals ranged from twelve to one hundred ninety-two weeks. After a failed intervention, a new fistula or graft was the most common access option (50%). This was followed by central catheter (38.5%), venous bypass (7.7%), and peritoneal dialysis catheter (3.8%). Morbidity was 0.99%. The in-hospital mortality was zero.

Conclusion: Overall PTA success rate for non-recurrent and first operation of recurrent patients with CVOD was high (74%). Stenotic type of lesions were the best vessels to dilate. Failure of PTA was directly related to previous right subclavian catheter insertion, multiple central vein catheter insertions, lesions in the right innominate vein, and an abrupt type of central vein occlusion. The current strategy of PTA for CVOD is both safe and effective. Early AVF creation can prevent patients from requiring multiple catheter insertions and developing CVOD. The right internal jugular vein is the optimal choice for access, while subclavian vein access should be avoided.