Balloon angioplasty vs nitinol stent placement in the treatment of venous anastomotic stenoses of hemodialysis grafts after surgical thrombectomy

• Published in: Journal of vascular surgery Vol. 55; no. 2; pp. 472 - 478
• Main Authors: Kakisis, John D., MD, Avgerinos, Efthymios, MD, Giannakopoulos, Triantafyllos, MD, Moulakakis, Konstantinos, MD, Papapetrou, Anastasios, MD, Liapis, Christos D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Alloys; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Arteriovenous Shunt, Surgical - adverse effects; Axillary Vein - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation - adverse effects; Brachial Artery - surgery; Chi-Square Distribution; Emergency and intensive care: renal failure. Dialysis management; Female; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - surgery; Graft Occlusion, Vascular - therapy; Greece; Humans; Intensive care medicine; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Proportional Hazards Models; Prospective Studies; Prosthesis Design; Renal Dialysis; Risk Assessment; Risk Factors; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombectomy - adverse effects; Thrombosis - etiology; Thrombosis - physiopathology; Thrombosis - therapy; Time Factors; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Thrombectomy; Treatment; Hemodialysis; Surgery; Cardiovascular disease; Instrumental dilatation; Nitinol; Stent
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.08.043

Objective Most arteriovenous hemodialysis grafts fail ≤18 months after implantation, most commonly due to intimal hyperplasia at the venous anastomosis. This open prospective study compared balloon angioplasty vs nitinol stent placement in the treatment of venous anastomotic stenosis after thrombectomy of prosthetic brachial-axillary accesses. Methods Between February 2007 and December 2010, 61 patients with an initial thrombosis of a prosthetic brachial-axillary access were admitted to our hospital. Of these patients, 28 (46%), treated before June 2008, underwent thrombectomy plus balloon angioplasty of the venous anastomosis (group A), whereas the remaining 33 (54%) patients, who were treated after July 2008, underwent graft thrombectomy plus angioplasty with self-expanding nitinol stent placement (group B). Primary, primary-assisted, and secondary patency rates were calculated using Kaplan-Meier analysis and compared between the two groups with the log-rank test. Results Primary patency was 32% at 3 months, 24% at 6 months, and 14% at 12 months in group A, and the respective values were 85%, 63% and 49% in group B. Primary patency was significantly better in group B than in group A ( P < .001; log-rank test). Cumulative median patency was 60 days in group A and 260 days in group B. Patient age, sex, comorbidities, graft material, and graft age did not have prognostic significance. Primary-assisted and secondary patency rates were significantly higher in group B. Conclusions Graft thrombectomy plus angioplasty with self-expanding nitinol stent placement provides significantly higher patency rates compared with thrombectomy plus plain balloon angioplasty of the venous anastomosis.