Brachiocephalic Venoplasty and Stenting in patients with central venous stenosis

Brachiocephalic vein (BCV) stenosis is an important complication seen in arteriovenous fistula (AVF) used for maintenance hemodialysis. Five patients on chronic hemodialysis were detected to have BCV stenosis. Percutaneous transluminal angioplasty (PTA) with or without stenting has become the preferred treatment for BCV stenosis. Several techniques have been described to perform central venous interventions. One of the techniques described in the literature is the ‘Antegrade-retrograde” technique. We used a modified ‘Antegrade-retrograde’ technique to perform the venoplasty in these five patients. The BCV stenosis could be crossed antegradely in 4 (80.0%) patients while in one (20%) patient, with complete stenosis, the lesion could only be crossed using a retrograde approach. Venoplasty and primary stenting was performed with good immediate and 6 months clinical follow up results. The modified ‘Antegrade-retrograde’ technique was found to be helpful in crossing the subtotal and totally occluded BCV of the dysfunctional AVF and for performing the revascularization procedure.