Effectiveness of Stent-graft Placement for Salvage of Dysfunctional Arteriovenous Hemodialysis Fistulas

• Published in: Journal of vascular and interventional radiology Vol. 21; no. 4; pp. 496 - 502
• Main Authors: Bent, Clare L., MBBCh, FRCR, Rajan, Dheeraj K., MD, FRCPC, Tan, Kongteng, FRCS, FRCR, FRCPC, Simons, Martin E., MD, FRCPC, Jaskolka, Jeff, MD, FRCPC, Kachura, John, MD, FRCPC, Beecroft, Robert, MD, FRCPC, Sniderman, Kenneth W., MD, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2010
• Subjects: Aged; Arteriovenous Shunt, Surgical - instrumentation; Arteriovenous Shunt, Surgical - methods; Blood Vessel Prosthesis; Female; Humans; Male; Radiology; Renal Dialysis - instrumentation; Renal Dialysis - methods; Salvage Therapy - methods; Stents; Treatment Outcome; Vascular Patency; PTA; percutaneous transluminal angioplasty
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2009.12.395

Purpose To determine the clinical effectiveness of stent-graft placement in dysfunctional autogenous hemodialysis fistulas. Materials and Methods Between September 2006 and June 2008, 24 Fluency Plus stent-grafts were inserted in 17 patients with failing autogenous hemodialysis fistulas (two radiocephalic, 12 brachiocephalic, and three brachiobasilic). Six fistulas were thrombosed at presentation. Indications for stent-graft insertion included 10 residual stenoses, six pseudoaneurysms, and one fistuloplasty-induced rupture. Fistula function before and after intervention was assessed with ultrasound dilution technique. Results The technical success rate was 100%, as were the anatomic and clinical success rates. Via Kaplan-Meier method, the primary access patency rates were 94.1% at 3 months (95% CI, 0.461–0.995) and 88.2% at 6 and 12 months (95% CI, 0.468–0.980). The primary lesion patency rate was 94.1% (95% CI, 0.650–0.992) at 3, 6, and 12 months. The secondary access patency rate had a point estimate of 100% at 3 months, and was 93.8% (95% CI, 0.632–0.991) at 6 and 12 months. Univariate analysis suggested that male sex and left-sided accesses were associated with a longer primary access patency rate ( P = .02). The binary restenosis rate at 6 months was 5.9%. Mean transonic flow rates were 667.5 mL/min before intervention and 2,076.0 mL/min after intervention ( P = .03, Wilcoxon signed-rank test). No patients were lost to follow-up. Conclusions Stent-graft placement in dysfunctional autogenous hemodialysis fistulas is technically feasible and effective in preserving function and preventing access abandonment, with patency rates that exceed historical patency rates with angioplasty and/or uncovered stents.