Advertisement

CardioVascular and Interventional Radiology

, Volume 35, Issue 4, pp 832–838 | Cite as

Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

  • Charles Y. Kim
  • Daniel J. Tandberg
  • Michael D. Rosenberg
  • Michael J. Miller
  • Paul V. Suhocki
  • Tony P. Smith
Clinical Investigation

Abstract

Purpose

To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts.

Methods

Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group.

Results

Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01).

Conclusion

The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

Keywords

Arteriovenous graft Covered stent Hemodialysis Stent Stent graft 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Kanterman RY, Vesely TM, Pilgram TK et al (1995) Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology 195:135–139PubMedGoogle Scholar
  2. 2.
    Anonymous (2006) Clinical practice guidelines for vascular access. Am J Kidney Dis 48(suppl 1):S176–S247Google Scholar
  3. 3.
    Lilly RZ, Carlton D, Barker J et al (2001) Predictors of arteriovenous graft patency after radiologic intervention in hemodialysis patients. Am J Kidney Dis 37:945–953PubMedCrossRefGoogle Scholar
  4. 4.
    Yevzlin AS, Maya ID, Asif A (2009) Endovascular stents for dialysis access: under what circumstances do the data support their use? Adv Chronic Kidney Dis 16:352–359PubMedCrossRefGoogle Scholar
  5. 5.
    Haskal ZJ, Trerotola S, Dolmatch B et al (2010) Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med 362:494–503PubMedCrossRefGoogle Scholar
  6. 6.
    Kwa AT, Yeo KK, Laird JR (2010) The role of stent-grafts for prevention and treatment of restenosis. J Cardiovasc Surg 51:579–589Google Scholar
  7. 7.
    Vogel PM, Parise C (2005) Comparison of SMART stent placement for arteriovenous graft salvage versus successful graft PTA. J Vasc Interv Radiol 16:1619–1626PubMedCrossRefGoogle Scholar
  8. 8.
    Chan MR, Bedi S, Sanchez RJ et al (2008) Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistulae. Clin J Am Soc Nephrol 3:699–705PubMedCrossRefGoogle Scholar
  9. 9.
    Maya ID, Allon M (2006) Outcomes of thrombosed arteriovenous grafts: comparison of stents vs angioplasty. Kidney Int 69:934–937PubMedCrossRefGoogle Scholar
  10. 10.
    Hoffer EK, Sultan S, Herskowitz MM et al (1997) Prospective randomized trial of a metallic intravascular stent in hemodialysis graft maintenance. J Vasc Interv Radiol 8:965–973PubMedCrossRefGoogle Scholar
  11. 11.
    Liang HL, Pan HB, Lin YH et al (2006) Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation. Korean J Radiol 7:118–124PubMedCrossRefGoogle Scholar
  12. 12.
    Pan HB, Liang HL, Lin YH et al (2005) Metallic stent placement for treating peripheral outflow lesions in native arteriovenous fistula hemodialysis patients after insufficient balloon dilatation. AJR Am J Roentgenol 184:403–409PubMedGoogle Scholar
  13. 13.
    Sreenarasimhaiah VP, Margassery SK, Martin KJ, Bander SJ (2005) Salvage of thrombosed dialysis access grafts with venous anastomosis stents. Kidney Int 67:678–684PubMedCrossRefGoogle Scholar
  14. 14.
    Patel RI, Peck SH, Cooper SG et al (1998) Patency of Wallstents placed across the venous anastomosis of hemodialysis grafts after percutaneous recanalization. Radiology 209:365–370PubMedGoogle Scholar
  15. 15.
    Dale JD, Dolmatch BL, Duch JM et al (2010) Expanded polytetrafluoroethylene-covered stent treatment of angioplasty-related extravasation during hemodialysis access intervention: technical and 180-day patency. J Vasc Interv Radiol 21:322–326PubMedCrossRefGoogle Scholar
  16. 16.
    Webb KM, Cull DL, Carsten CG 3rd et al (2010) Outcome of the use of stent grafts to salvage failed arteriovenous accesses. Ann Vasc Surg 24:34–38PubMedCrossRefGoogle Scholar
  17. 17.
    Bent CL, Rajan DK, Tan K et al (2010) Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas. J Vasc Interv Radiol 21:496–502PubMedCrossRefGoogle Scholar
  18. 18.
    Kariya S, Tanigawa N, Kojima H et al (2009) Peripheral stent placement in hemodialysis grafts. Cardiovasc Intervent Radiol 32:960–966PubMedCrossRefGoogle Scholar
  19. 19.
    Shemesh D, Goldin I, Zaghal I et al (2008) Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg 48:1524–1531PubMedCrossRefGoogle Scholar
  20. 20.
    Turmel-Rodrigues L, Pengloan J, Baudin S et al (2000) Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 15:2029–2036PubMedCrossRefGoogle Scholar
  21. 21.
    Kian K, Asif A (2008) Cephalic arch stenosis. Semin Dial 21:78–82PubMedCrossRefGoogle Scholar
  22. 22.
    Rajan DK, Clark TW, Patel NK et al (2003) Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol 14:567–573PubMedCrossRefGoogle Scholar
  23. 23.
    Valji K, Bookstein JJ, Roberts AC, Davis GB (1991) Pharmacomechanical thrombolysis and angioplasty in the management of clotted hemodialysis grafts: early and late clinical results. Radiology 178:243–247PubMedGoogle Scholar
  24. 24.
    Gibbens DT, Triolo J, Yu T et al (2001) Contemporary treatment of thrombosed hemodialysis grafts. Tech Vasc Interv Radiol 4:122–126PubMedCrossRefGoogle Scholar
  25. 25.
    Patel AA, Tuite CM, Trerotola SO (2005) Mechanical thrombectomy of hemodialysis fistulae and grafts. Cardiovasc Intervent Radiol 28:704–713PubMedCrossRefGoogle Scholar
  26. 26.
    Vesely TM, Amin MZ, Pilgram T (2008) Use of stents and stent grafts to salvage angioplasty failures in patients with hemodialysis grafts. Semin Dial 21:100–104PubMedCrossRefGoogle Scholar
  27. 27.
    Kolandaivelu K, Swaminathan R, Gibson WJ et al (2011) Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer-drug coatings. Circulation 123:1400–1409PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Charles Y. Kim
    • 1
  • Daniel J. Tandberg
    • 1
  • Michael D. Rosenberg
    • 1
  • Michael J. Miller
    • 1
  • Paul V. Suhocki
    • 1
  • Tony P. Smith
    • 1
  1. 1.Division of Vascular and Interventional RadiologyDuke University Medical CenterDurhamUSA

Personalised recommendations