Determinants of technical success and mid-term patency rates of endovascular recanalization of thoracic central venous obstruction in patients on renal replacement therapy: A single-centre study

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Aim: To evaluate the factors affecting the technical success and patency rates of endovascular recanalization of thoracic central venous obstruction. To evaluate the differences in patency rates between various anatomical segments of stenosis of the thoracic central veins. A single centre Prospective study was conducted to include 72 patients of chronic kidney disease presenting with features of thoracic central venous obstruction and undergoing primary endovascular treatment from January 2018 to May 2023. Patient demographics, symptoms, existing co-morbid conditions, lesion location, history of previous jugular or subclavian catheter insertions were documented. Periodic follow-up was done as part of institutional protocol at 1, 3, 6, 12 months. Technical success was defined as residual stenosis <30%. Tapered beak morphology of venous obstruction p=0.05) and long segment occlusion (p=0.05) (defined as more than 5cm in the study) were associated with technical failure. Zones prone for extrinsic compression (from clavicle, first rib, and aorta in the retrosternal space) were a significant predictive factor of poor primary patency (p<0.01). In the two-year follow-up of venous stents, a higher number of stent restenosis was noted at the site of extrinsic compression in the costoclavicular space. Location of the stenosis/ occlusions in the areas of extrinsic compression was a significant negative predictor of patency. Majority of the stent restenosis occurred at the sites of extrinsic compression by the first rib.