title: Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation.
abstract: OBJECTIVE
  We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients.
  
  
  METHODS
  Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10 mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis.
  
  
  RESULTS
  No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (+/-standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%+/-9 and 88%+/-6, 41%+/-10 and 88%+/-6, 30%+/-10 and 77%+/-10, and 12%+/-8 and 61%+/-13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively.
  
  
  CONCLUSIONS
  Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
authors.forename: Yih-Huie
authors.initials: YH
authors.lastname: Lin
authors.forename: Chiung-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
authors.forename: Tung-Ho
authors.initials: TH
authors.lastname: Wu
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Pin-Hong
authors.initials: PH
authors.lastname: Lai
authors.forename: Chien-Fang
authors.initials: CF
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005542:Forearm; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D015607:Stents; D017211:Treatment Failure; D014654:Vascular Patency
chemical_list: D008670:Metals; D011138:Polytetrafluoroethylene