Pendekatan Klinis dan Manajemen Terkini terhadap Stenosis Vena Sentral pada Akses Vaskular Hemodialisis

Akita Rukmana Akbar; Novi Kurnianingsih

doi:10.11594/jk-risk.05.3.5

Authors

Akita Rukmana Akbar Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya / Dr. Saiful Anwar General Hospital.
Novi Kurnianingsih Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya / Dr. Saiful Anwar General Hospital, East Java Province

DOI:

https://doi.org/10.11594/jk-risk.05.3.5

Keywords:

Central vein stenosis, hemodialysis, vascular access, percutaneous transluminal angioplasty, vascular intervention

Abstract

Central vein stenosis (CVS) is a significant complication in hemodialysis (HD) patients, affecting vascular access longevity and patient outcomes. This review provides a comprehensive analysis of the anatomical, epidemiological, pathophysiological, clinical, diagnostic, and therapeutic aspects of CVS. The pathogenesis of CVS involves venous wall thickening, endoluminal obstruction, and extrinsic compression, with contributing factors such as prior central venous catheterization, high blood flow rates, and endothelial injury. Diagnosis is confirmed through imaging modalities, with venography being the gold standard. Management strategies range from percutaneous transluminal angioplasty (PTA) to stenting (bare metal and drug-eluting stents), surgical interventions, and alternative dialysis strategies for patients with severe CVS. Endovascular approaches, particularly angioplasty with stenting, remain first-line interventions, although restenosis rates necessitate repeated procedures. Emerging technologies, including drug-coated balloons and HeRO grafts, offer promising alternatives. Multidisciplinary collaboration between nephrologists, vascular surgeons, and interventional radiologists is essential for optimizing outcomes. This review highlights current international perspectives on CVS management and future directions for improving treatment efficacy and access preservation in HD patients.

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