Comparative Study between Surgical Management and Venoplasty with Stenting in Cases of Recurrent Venous Hypertension in Hemodialysis Patient.

Abstract

Background: Recurrent venous hypertension due to central venous stenosis or occlusion is a common complication in hemodialysis patients, often resulting from previous central venous catheterization. Endovascular treatments like balloon angioplasty and stenting offer initial relief but suffer from high recurrence rates, while surgical interventions provide alternative solutions when endovascular therapy fails.

Objective: to compare short-term outcomes between venoplasty with stenting and surgical management in recurrent venous hypertension secondary to central venous occlusion among hemodialysis patients.

Patients and Methods: This prospective randomized trial was conducted on 40 patients with recurrent venous hypertension, assigned to receive either endovascular stenting or surgical bypass. Clinical and imaging assessments were performed, with patency and symptom resolution evaluated at 1, 3 and 6 months.

Results: Postoperative arm circumference showed a significantly greater reduction in the surgical group (P=0.003), with both groups having significant within-group decreases (P<0.001) and no baseline differences (P=0.390). Similarly, forearm circumference reduction was significantly greater in the surgical group (P<0.001), with significant decreases in both groups post-intervention (P<0.001) and comparable preoperative measurements (P=0.201). Intraoperative venography findings differed significantly between groups (P=0.004), indicating more severe lesions in the surgical group, Procedure duration was significantly longer in the surgical group (P<0.001).

Conclusion: Surgical venous drainage provided superior primary patency and more effective early resolution of limb swelling compared to venoplas ty with stenting, despite longer operative time. Both interventions are effective in maintaining dialysis access, however venoplasty is safer compared to surgical venous drainage which is associated with higher 30-days mortality rate.