Management of hemodialysis catheter-induced cavoatrial junction lesion by VBX stent-graft

BACKGROUND: Hemodialysis catheter-induced cavoatrial junction (CAJ) stenosis or occlusion is a potentially severe condition. It not only leads to severe symptoms of superior vena cava (SVC) syndrome but also limits the establishment of vascular access in the upper extremities of hemodialysis patients. Endovascular therapy is the first-line treatment but has a high restenosis rate and potential fatal risks such as SVC rupture, cardiac tamponade, and stent malposition or migration during the procedure. Few studies focusing on CAJ management have been reported. OBJECTIVE: We evaluated the technical and clinical outcomes of Viabahn VBX stent grafts used for reconstructing the CAJ lesion in hemodialysis patients with SVC syndrome. METHODS: We retrospectively analyzed 12 patients with catheter-induced CAJ lesions who were treated with VBX stent grafts. Demographic data, clinical signs and symptoms, technical details, and clinical outcomes were recorded. RESULTS: The study included 8 females and 4 males, with a mean age of 48.3 ± 12.3 years (age range: 28-62 years). High-grade stenosis of the CAJ was detected in five cases, while occlusion was observed in seven cases, and among them, one case had an indwelling tunneled central catheter (TCC). The technical success rate was 100%, without any complications. After stent deployment, symptoms were alleviated in all cases. During the follow-up period (mean follow-up time of 18.9 ± 6.0 months), the primary patency rate of the target lesion at the CAJ reached 100%. CONCLUSIONS: Using a VBX stent-graft is a safe and effective method to treat CAJ lesion avoiding major fatal complication.