Characteristics and percutaneous transluminal angioplasty treatment outcomes of superior vena cava obstruction in patients undergoing hemodialysis.

Abstract

Background: This study aimed to investigate the clinical outcomes of percutaneous transluminal angioplasty (PTA) in patients undergoing hemodialysis with different types of superior vena cava obstruction (SVCO) lesions.

Methods: This retrospective observational study recruited patients undergoing hemodialysis with SVCO and analyzed the clinical characteristics of SVCO. Patency rates were collected for patients treated with PTA and were assessed using the t-test, U-test, log-rank test and survival analyses such as the Kaplan-Meier method.

Results: A total of 49 patients undergoing hemodialysis with SVCO were classified as type I (N.=17), type II (N.=7), type III (N.=15) and type IV (N.=10). All patients had a history of catheter placement. There were 14 cases of SVCO-related catheter dysfunction, and PTA was performed in 35 patients with a technical success rate of 77.14% (27/35). Failures were observed exclusively in eight patients with type III or IV lesions. The median follow-up was 15 (1.5-58) months, with 6- and 12-month post-PTA primary patency rates of 51.9% and 14.4%, respectively. The primary assisted patency rates were 70.2% and 55.2%, and the secondary patency rates were 92.6% and 78.0%, requiring 2.68 PTAs per patient per year to maintain them. Type I-II lesions demonstrated significantly higher primary patency and primary assisted patency rates than type III-IV lesions (P=0.007 and P=0.002).

Conclusions: Percutaneous transluminal angioplasty may be used to treat type I or II SVCO, achieving high technical success and patency rates. Patients undergoing hemodialysis with SVCO may have a condition related more to catheter placement than to arteriovenous fistula.