Endovascular management of brachiocephalic vein stenosis and occlusion in hemodialysis patients: Technical outcomes and 6-month dialysis access patency.

Objective: Central venous stenosis involving the brachiocephalic vein (BCV) is an important cause of upper limb swelling and hemodialysis access dysfunction. In Sri Lanka, central venous disease is increasingly encountered because many patients present late with end-stage kidney disease and require crash dialysis with multiple central venous catheter insertions before definitive arteriovenous fistula creation. Endovascular therapy is the first-line treatment. This study evaluates the technical outcomes and short-term clinical results of endovascular management of BCV lesions in a tertiary vascular unit. Methods: A retrospective analysis was performed of consecutive patients who underwent attempted endovascular treatment for BCV stenosis or occlusion over a 1-year period at a single tertiary care center. Demographic characteristics, clinical indications, lesion morphology, access routes, procedural details, and technical outcomes were analyzed. Results: Fifteen patients underwent attempted intervention. Mean age was 49 years (range, 21-76), with male predominance (80%). Left-sided disease was more frequent (66.7%). Stenosis accounted for 60% of lesions and occlusions for 40%. Balloon venoplasty alone was performed in eight patients (53.3%), whereas five patients (33.3%) required adjunctive stent placement using bare metal stents (diameter, 12-14 mm; length, 4-6 cm). Technical success was achieved in 13/15 cases (86.7%). Two procedures were abandoned due to chronic total occlusions that could not be crossed. During the follow-up, two patients developed early recoil after venoplasty within 6 months, one of whom required subsequent stent placement. At the mean follow-up of 6 months, symptom improvement was observed in all patients who had successful venoplasty or stenting. Except for one patient, all arteriovenous fistulas remained functional for hemodialysis. Conclusions: Endovascular management of BCV stenosis and occlusion is safe and effective, with high technical success and favorable short-term clinical outcomes. Balloon venoplasty remains the primary treatment, with selective stent placement providing durable results in cases of recoil or persistent stenosis. Chronic total occlusions remain the principal technical limitation.