Patency of Wallstents placed at the venous anastomosis of dialysis grafts for salvage of angioplasty-induced rupture.
OBJECTIVE
To retrospectively evaluate the patency of Wallstents placed at the venous anastomosis of polytetraflouroethylene (PTFE) hemodialysis grafts to preserve function following angioplasty-induced rupture.


METHODS
The charts of all patients who underwent percutaneous angioplasty of functioning hemodialysis PTFE grafts between September 1997 and September 2001 were retrospectively reviewed. A total of 414 angioplasties were performed. Nine cases of rupture at the venous anastomosis managed with stent placement were identified (7 women, 2 men). Two grafts were loop grafts, seven grafts were straight grafts. All stents placed were Wallstents; six stents were 8 x 40 mm, the remaining three were 8 x 20 mm, 8 x 60 mm and 10 x 42 mm. Average follow-up was 13 months.


RESULTS
Technical and clinical success of stent placement was 100%. The primary patency rates (+/- SE) of stents placed at the venous anastomosis were 88% (12%) at 30 days, 63% (17%) at 90 days, 33% (18%) at 180 days and 17% (15%) at 360 days. The secondary patency rates (+/- SE) were 89% (11%) at 90 days, 76% (15%) at 180 days and 69% (23%) (6 stents patent) at 360 days. During follow-up, one graft was removed because of infection, one patient died and another was lost to follow-up. A single minor complication of a puncture site hematoma occurred (11%) with no major complications.


CONCLUSIONS
This small retrospective series suggests that Wallstent placement following angioplasty-induced venous anastomotic rupture is effective for preserving dialyzable flow in hemodialysis grafts. Patency is comparable to that of stents placed for reasons other than rupture.
Rajan
Dheeraj K
DK
Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network-University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
Clark
Timothy W I
TW
D000368:Aged; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012421:Rupture / Q000209:etiology / Q000503:physiopathology; D016879:Salvage Therapy; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D014680:Veins / Q000293:injuries* / Q000503:physiopathology*