Stent-graft arteriovenous fistula: an endovascular technique in hemodialysis access

• Published in: Journal of endovascular surgery Vol. 5; no. 1; p. 18
• Main Authors: Masuda, E M, Kistner, R L, Eklof, B, Lipman, R A, Balkin, P W, Kamida, C B
• Format: Journal Article
• Language: English
• Published: United States 01.02.1998
• Subjects: Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical - methods; Catheters, Indwelling; Feasibility Studies; Female; Humans; Male; Middle Aged; Polytetrafluoroethylene; Prostheses and Implants; Renal Dialysis; Stents
• ISSN: 1074-6218
• DOI: 10.1583/1074-6218(1998)005<0018:SGAFAE>2.0.CO;2

To determine the feasibility and safety of a new endovascular technique for creating an arteriovenous (AV) fistula utilizing catheter-directed techniques and stents. Stent-graft AV fistulas were offered on an experimental basis to 8 patients who had a history of multiple failed access procedures or very small arm veins unsuitable for standard vascular access techniques. The device consisted of a balloon-expandable Palmaz stent attached to the designated venous end of a polytetrafluoroethylene graft. The balloon-mounted stent-graft was inserted into the brachial vein through an arteriotomy and advanced over a guidewire into the axillary vein. After the stent-graft was deployed, the arterial anastomosis was completed in standard surgical fashion using an end-to-side anastomosis of the graft to the brachial artery. The stent-graft was inserted successfully in all patients, but there were two early failures. The first resulted from a steal phenomenon secondary to high flows through the stent-graft, necessitating ligation of the fistula. Another stent-graft was placed too peripherally in the upper arm, and the stainless steel stent was crushed by external compression. Three of the 6 remaining grafts were patent for over 1 year, and 2 grafts are still functioning at 22 and 13 months. Endoluminal stent-grafts can be successfully inserted into the axillary vein for creation of an AV fistula and remain patent for 2 years or more. This method may be most useful in patients with very small, unusable arm veins or multiple failed AV grafts.