Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas.
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.
Bent
Clare L
CL
Department of Medical Imaging, University Health Network and Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. clare_bent@yahoo.co.uk
Rajan
Dheeraj K
DK
Tan
Kongteng
K
Simons
Martin E
ME
Jaskolka
Jeff
J
Kachura
John
J
Beecroft
Robert
R
Sniderman
Kenneth W
KW
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