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Chronic Total Venous Occlusions (CTVO) are one of the many challenges physicians have to confront in the daily treatment of
patients with End Stage Renal Disease (ESRD). Even in cases where an arteriovenous fistula is present, central venous occlusions
may occur and be a hassle for the culmination of therapy by hemodialysis. A total of 79 patients with CTVO has undergone reopening
of the vessels in our institution, of those 29 had ESRD. The 29 patients comprised: 17 females and 12 males. The mean age was
17 years (8- 76 years). One female patient was lost to follow up. The time at presentation was a mean of 4 months (3-9 months). The
majority of patients had swelling of one extremity or face, and difficulty with dialysis upon presentation. A total of 48 percutaneous
interventions were carried out. In all the patients, we were able to open the anomalous vessel. Twelve (12) patients required more
than 1 intervention to maintain patency of their diseased vessel. The shortest time to need another procedure was 1 month, and the
longest 25 months. Stents were implanted in 11 patients with 2 requiring more than 1 stent in different occasions. Of the patients with
only 1 procedure, the range without re-interventions is from 1 month to 5 years. The most commonly intervened vessels were central
thoracic veins. With the application of simple methods of reopening the CTVO percutaneously, we have achieved a good medium
term patency in patients with ESRD. With newer technologies however, possibly adapted from arterial interventions, the longevity of
these accesses may be prolonged.
Edwin Rodriguez-Cruz has completed Doctorate degree from the San Juan Bautista School of Medicine, PR. He specializes in Internal Medicine & Pediatrics. He completed Pediatric Cardiology fellowship and sub-fellowship in Interventional Cardiology from the Children's Hospital of Michigan. Currently, he is the Director of Cardiology of the San Jorge Children's Hospital, and Associate Professor of Medicine and Pediatrics at the San Juan Bautista School of Medicine, PR, USA. He has published over 20 articles in peer review journals and many specialty opinions by editors' request. His interests are in the areas of heart failure, structural heart diseases, and difficult venous accesses. He has special interest in chronic total venous occlusions (CTVO).