Expanded polytetrafluoroethylene-covered stent treatment of angioplasty-related extravasation during hemodialysis access intervention: technical and 180-day patency.
OBJECTIVE
To review technical and patency results with expanded polytetrafluoroethylene (ePTFE)-covered stents for treatment of venous rupture encountered during percutaneous hemodialysis intervention.


METHODS
The Fluency covered stent is a tracheobronchial device that was used in an off-label manner to treat percutaneous transluminal angioplasty (PTA)-induced rupture in hemodialysis circuits. Data were retrospectively reviewed for all patients treated with the stent in 2004-2005 at two medical centers for PTA-related rupture.


RESULTS
From a database of 106 procedures, 21 patients (21 procedures) were treated with the ePTFE-covered stent for PTA-related extravasation. Nine patients had arteriovenous (AV) grafts and 12 had AV fistulas. Five extravasations followed angioplasty as part of an AV graft declotting procedure. Location of extravasation was the outflow or cannulation venous segment (n = 11), cephalic arch (n = 3), AV graft venous anastomosis (n = 6), and intragraft (n = 1). All procedures were technically successful at halting extravasation and preserving vascular access. There were no known complications, and all patients underwent a successful first dialysis session. Twenty of the 21 circuits remained patent beyond the first week after intervention. The 180-day primary circuit patency rate was 20% and the 180-day cumulative circuit patency rate was 65%.


CONCLUSIONS
In 21 patients, the ePTFE-covered stent successfully treated PTA-induced rupture with no need for acute secondary procedures such as thrombolysis or surgery. There was no instance of pseudoaneurysm formation or delayed bleeding. The ePTFE-covered stent offers advantages compared to prolonged PTA or bare stents when attempting to preserve hemodialysis access after PTA-induced rupture.
Dale
Jarrod D
JD
Division of Interventional Radiology, University of Texas Southwestern Medical Center, P.O. Box 1, Suite 600, 5959 Harry Hines Blvd., Dallas, TX 75390-8834, Texas, USA. jarrod.dale@alumni.utsouthwestern.edu
Dolmatch
Bart L
BL
Duch
John M
JM
Winder
Richard
R
Davidson
Ingemar J
IJ
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001807:Blood Vessel Prosthesis; D020099:Coated Materials, Biocompatible / Q000737:chemistry; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005465:Fluorocarbon Polymers / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D015607:Stents; D014654:Vascular Patency
D020099:Coated Materials, Biocompatible; D005465:Fluorocarbon Polymers; C010946:polytetrafluoroethane