CENTRAL VENOPLASTY/STENTING

>  What is central venous stenosis:

• • It is a disease in which blood flow from head and both upper limbs to heart is compromised due to blockage in central venous channels (vascular channel). This leads to swelling in upper limb and/or face.
  • This is disease is commonly found in dialysis patients.

>  What are the reasons for this condition:

• • Most common reason (for more than 90% of cases) for this disease is dialysis catheter insertion through neck vessels.
  • Other uncommon reasons include compression of neck vessels by mass lesions (e.g. lymphoma, goitre, thoracic aortic aneurysm, mediastinal fibrosis etc.), hyper-coagulopathy, thoracic outlet syndrome or pacemaker wires etc.

>  What are the symptoms and how it diagnosed:

• • Most common symptoms include upper limb/face swelling, difficulty in dialysis through dialysis catheter or fistula.
  • This disease diagnosed with CT scan or angiography (central venography).

>  Why it necessary to treat:

• • Treatment is necessary for reducing swelling and making dialysis possible through fistula or dialysis catheter.
  • If left untreated, it can leads to upper limb skin ulceration and intracranial bleed in rare cases.

>  How to treat:

• • It can be treated with either surgical method or intervention method.
  • Surgical method involves opening of chest wall and putting bypass graft. It is complex and high risk surgery particularly for dialysis patient.
  • Intervention method includes small pinhole vascular channel followed by opening of vessel blockage with either balloon or stent without any stitches or scar mark.

 >  What are the benefits of IR method:

• • Minimal invasive procedure with small pinhole. No need of stitch or scar mark.
  • Patient can get discharge on same day and can do all routine work just after few hours of treatment.

>  Preparation for procedure:

• • Few basic blood investigations like CBC, PT/INR, viral markers, serum electrolytes.
  • Bring all the records including imaging record.
  • Signing consent form.

> What are risks:

• • Very few and rare; hematoma, vessel wall damage, thromboembolism (<1 case in 1000).