title: Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas.
abstract: OBJECTIVE
  To determine the clinical effectiveness of stent-graft placement in dysfunctional autogenous hemodialysis fistulas.
  
  
  METHODS
  Between September 2006 and June 2008, 24 Fluency Plus stent-grafts were inserted in 17 patients with failing autogenous hemodialysis fistulas (two radiocephalic, 12 brachiocephalic, and three brachiobasilic). Six fistulas were thrombosed at presentation. Indications for stent-graft insertion included 10 residual stenoses, six pseudoaneurysms, and one fistuloplasty-induced rupture. Fistula function before and after intervention was assessed with ultrasound dilution technique.
  
  
  RESULTS
  The technical success rate was 100%, as were the anatomic and clinical success rates. Via Kaplan-Meier method, the primary access patency rates were 94.1% at 3 months (95% CI, 0.461-0.995) and 88.2% at 6 and 12 months (95% CI, 0.468-0.980). The primary lesion patency rate was 94.1% (95% CI, 0.650-0.992) at 3, 6, and 12 months. The secondary access patency rate had a point estimate of 100% at 3 months, and was 93.8% (95% CI, 0.632-0.991) at 6 and 12 months. Univariate analysis suggested that male sex and left-sided accesses were associated with a longer primary access patency rate (P = .02). The binary restenosis rate at 6 months was 5.9%. Mean transonic flow rates were 667.5 mL/min before intervention and 2,076.0 mL/min after intervention (P = .03, Wilcoxon signed-rank test). No patients were lost to follow-up.
  
  
  CONCLUSIONS
  Stent-graft placement in dysfunctional autogenous hemodialysis fistulas is technically feasible and effective in preserving function and preventing access abandonment, with patency rates that exceed historical patency rates with angioplasty and/or uncovered stents.
authors.affiliation: Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. clare_bent@yahoo.co.uk
authors.forename: Clare L
authors.initials: CL
authors.lastname: Bent
authors.forename: Dheeraj K
authors.initials: DK
authors.lastname: Rajan
authors.forename: Kongteng
authors.initials: K
authors.lastname: Tan
authors.forename: Martin E
authors.initials: ME
authors.lastname: Simons
authors.forename: Jeff
authors.initials: J
authors.lastname: Jaskolka
authors.forename: John
authors.initials: J
authors.lastname: Kachura
authors.forename: Robert
authors.initials: R
authors.lastname: Beecroft
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sniderman
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation / Q000379:methods*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency