DIALYSIS ACCESS-RELATED RECURRENT THORACIC CENTRAL VEIN OCCLUSION RECANALIZATION AND STENT DEPLOYMENT (DECORE)

 

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DIALYSIS ACCESS-RELATED RECURRENT THORACIC CENTRAL VEIN OCCLUSION RECANALIZATION AND STENT DEPLOYMENT (DECORE)

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Chye Chung
Gan
Chye Chung Gan ccgan@ummc.edu.my Faculty of Medicine, University of Malaya Division of Nephrology, Department of Medicine Kuala Lumpur Malaysia *
Soo Ying Yew syyew@ummc.edu.my University Malaya Medical Centre Division of Nephrology, Department of Medicine Kuala Lumpur Malaysia -
Yi-De Ng ng.yide@ummc.edu.my Faculty of Medicine, University Malaya Medical Centre Department of Biomedical Imaging Kuala Lumpur Malaysia -
Wan Mohammad Ibrahim Wan Azman wanibrahim@ummc.edu.my University Malaya Medical Centre Department of Biomedical Imaging Kuala Lumpur Malaysia -
Kin Wong Chan kwchan@ummc.edu.my University Malaya Medical Centre Department of Biomedical Imaging Kuala Lumpur Malaysia -
Eric Chung eric.chung@ummc.edu.my Faculty of Medicine, University Malaya Medical Centre Department of Biomedical Imaging Kuala Lumpur Malaysia -
Wei Lin Ng wei.lin@ummc.edu.my Faculty of Medicine, University Malaya Medical Centre Department of Biomedical Imaging Kuala Lumpur Malaysia -
Daoyao Ling daoyao@ummc.edu.my University Malaya Medical Centre Vascular Unit, Division of General Surgery, Department of Surgery Kuala Lumpur Malaysia -
Muhammad Syafiq Idris syafiq.idris@ummc.edu.my University Malaya Medical Centre Vascular Unit, Division of General Surgery, Department of Surgery Kuala Lumpur Malaysia -
Ahmad Rafizi Hariz Ramli rafizihariz@ummc.edu.my Faculty of Medicine, University Malaya Medical Centre Vascular Unit, Division of General Surgery, Department of Surgery Kuala Lumpur Malaysia -
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Thoracic central vein occlusion (TCVO) has a high incidence of recurrence post-central venoplasty. Stent placement is indicated for acute elastic recoil or stenosis recurrence within 3 months. However, the poor post-intervention patency rate in the current available literature can potentially be explained by using non-venous dedicated central venous stenting in hemodialysis patients. This study addresses a research gap regarding the use of the dedicated nitinol open-cell venous stent, Venovo (BD, Karlsruhe, Germany), for treating TCVO in hemodialysis patients. Currently, limited data exist on its exclusive application within this specific population.

We retrospectively analysed data from our institution, including percutaneous endovascular interventions performed between January 1, 2023, and October 15, 2025, with a focus on dialysis access-related TCVO. Baseline demographic, access, lesion, and intervention characteristics were collected using institution electronic medical record (Figure 1-4). Our primary outcome was post intervention patencies—primary, primary-assisted, and secondary (Figure 5). We also examined survival analysis of primary patency before and after stent deployment in patients with recurrent TCVO, employing Cox proportional hazards modelling.

Seventeen patients underwent recanalization with Venovo stents; four were excluded due to follow-up less than one month, leaving twelve patients for baseline and post-intervention analyses. Three had no prior intervention. Nine patients were evaluated for pre- and post-stent primary patency. The mean follow-up was 12.98+2.81 (95% CI; 6.80, 19.16). The mean age of the 12 patients was 65.00+3.36 (95% CI; 57.83, 72.17), equal gender distribution of 50% male, with a dialysis vintage of 51.58+5.23 months, mostly of Malay ethnicity. Technical success was 100%. Post-stent primary patency rates were 100% at 1 and 3 months, decreasing to 50% at 12 and 24 months. Kaplan-Meier analysis showed the mean primary patency was significantly longer post-stent (16.76 months) compared to pre-stent (5.30 months), with a hazard ratio indicating a 82% reduction in patency loss risk with Venovo stent use (p=0.013)- Figure 6.

Figure 1 Demographic Figure 2 AccessFigure 3 Lesions Figure 4 Interventions

Figure 5 Patencies


The Venovo stent appears feasible for dialysis-related TCVO, offering comparable patency outcomes and significantly reducing the risk of recurrent occlusion. Loss of post-intervention access patency is reduced by 82% with the Venovo stent versus no stent at any given time over 24 months.

Kewords