Abstract: 【Abstract】Objective We investigated the clinical effect, medical expenses and protection of vascular resources in the treatment of central venous stenosis in maintenance hemodialysis (MHD) patients. We also explored the effect of reimbursement ratio by medical insurance on the choice of treatment methods. Method The MHD patients with central venous stenosis first diagnosed in the period from Jan. 2013 to Oct. 2016 were recruited in this study. The lesion side was accompanied by an arteriovenous fistula. They were treated with percutaneous transluminal angioplasty (PTA), percutaneous transluminal stenting (PTS) or pathway reconstruction. They were followed up for 3, 6 and 12 months. Hospitalization duration, total expenses, the payment part by patients, treatment methods, and the use of blood vessel resources were recorded. Results A to-tal of 27 patients (12 males and 15 females) were enrolled in this study. A history of central venous catheterization was found in 96.30% of patients. PTA, PTS and pathway reconstruction were adopted in 12, 4 and 11 patients, respectively. (a) After PTA for 3, 6 and 12 months, the primary patency rates were 91.67%, 58.33% and 41.67%, respectively, and the secondary patency rates were 100%, 83.33% and 58.33%, respectively. After PTS for 3, 6 and 12 months, the primary patency rates were 100.00%, 75.00% and 50.00%, respectively, and the secondary patency rates were 100.00%, 100.00% and 75.00%, respectively. PTA, PTS or pathway reconstruction had to be conducted after central venous catheterization for 6.36±2.69 months, 9.00±4.24 months and 1.73±0.26 months, respectively. Patients treated with pathway reconstruction were hospitalized after removal of the catheters. (b) Hospitalization duration was shorter in patients with PTA and PTS (for PTA, 6.58±0.67 vs. 11.45±1.75 days, t=-8.657, P＜0.001; for PTS, 9.00±0.82 vs. 11.45±1.75 days, t=-3.675, P=0.003). However, the medical expenses for PT and PTS were higher than those of pathway reconstruction (compared to PTA, 21788.16±1246.29 vs. 12966.36±902.44 Yuan, t=19.557, P＜0.001; compared to PTS, 33853.50±1524.99 vs. 12966.36±902.44 Yuan; t=25.800, P＜0.001). The payment part by patients was similar in patients treated with PTA and those with pathway reconstruction 5056.36±1795.27 vs. 4510.09±916.26 Yuan, t=0.930, P=0.366). (c) PTA and PTS had the advantage of vascular resource preservation and protection, and only one blood vessel was used for PTA and PTS. In contrast, 4 blood vessels had to be used for pathway reconstruction. (d) Patients with higher payment ratio by medical insurance tended to choose PTA or PTS (72.73%,100.00% vs. 33.33%), while those with lower payment ratio by medical insurance chose pathway reconstruction. Conclusions Endovascular treatment had the advantages of better effects, lower expenses and preservation of blood vessel resources, especially the endovascular treatment of PTA. The payment ratio by medical insurance affected the treatment method. With the increase of reimbursement ratio by medical insurance, endovascular treatment is the first choice for the treatment of central venous stenosis.

Key words: Hemodialysis, Central venous stenosis, Percutaneous endovascular treatment, Treatment expense, Reimbursement way