Edwin RodrÃguez-Cruz
San Juan Bautista School of Medicine, USA.
Title: Treatment of chronic total venous occlusions in patients with end stage renal disease
Biography
Biography: Edwin RodrÃguez-Cruz
Abstract
Chronic Total Venous Occlusions (CTVO) are one of the many challenges physicians have to confront in the daily treatment of patients with End Stage Renal Disease (ESRD). Even in cases where an arteriovenous fistula is present, central venous occlusions may occur and be a hassle for the culmination of therapy by hemodialysis. A total of 79 patients with CTVO has undergone re-opening of the vessels in our institution, of those 29 had ESRD. The 29 patients comprised: 17 females and 12 males. The mean age was 17 years (8- 76 years). One female patient was lost to follow up. The time at presentation was a mean of 4 months (3-9 months). The majority of patients had swelling of one extremity or face, and difficulty with dialysis upon presentation. A total of 48 percutaneous interventions were carried out. In all the patients, we were able to open the anomalous vessel. Twelve (12) patients required more than 1 intervention to maintain patency of their diseased vessel. The shortest time to need another procedure was 1 month, and the longest 25 months. Stents were implanted in 11 patients with 2 requiring more than 1 stent in different occasions. Of the patients with only 1 procedure, the range without re-interventions is from 1 month to 5 years. The most commonly intervened vessels were central thoracic veins. With the application of simple methods of reopening the CTVO percutaneously, we have achieved a good medium term patency in patients with ESRD. With newer technologies however, possibly adapted from arterial interventions, the longevity of these accesses may be prolonged.