title: Stent-grafts improve secondary patency of failing hemodialysis grafts.
abstract: OBJECTIVE
  Failing hemodialysis grafts continue to pose a challenge in the care of patients with end-stage renal disease (ESRD). We review our experience using percutaneous stent-grafts for the treatment of venous outflow stenosis and occlusion in order to assess their efficacy in nonautologous graft salvage.
  
  
  METHODS
  This is a retrospective review of patients treated with percutaneous Viabahn® stent-grafts for failing hemodialysis arteriovenous grafts (AVGs), between 6/2006 and 12/2009. All stent-grafts were deployed across the venous anastomosis to address the outflow obstruction. Patency and re-intervention rates were estimated using Kaplan-Meier analysis.
  
  
  RESULTS
  Twenty patients had stent-grafts placed. Successful stent-grafting was defined as <30% residual stenosis and the ability to dialyze through the graft post-treatment. Technical success for stent-grafting was 100%. Median follow-up was 23 months (range 3 to 37 months). Stent-graft patency at 6 months: 94.7%, 12 months: 94.7%, 18 months: 82.1%, 24 months: 82.1%, 36 months: 82.1%. Freedom from re-intervention was 69% at 24 months and 50% at 36 months. Two AVGs failed and had to be removed without further interventions, because of complete occlusion and infection. Two patients (10%) required re-intervention for arterial inflow stenosis. One patient (5%) required balloon angioplasty and stenting of stenosis distal to the stent-graft. One patient (5%) developed in-stent stenosis and was treated with placement of a new stent. Graft salvage rate was 80% at 36 months.
  
  
  CONCLUSIONS
  Stent-grafts can be successfully used to improve freedom from re-intervention rates and overall patency rates of failing AVGs.
authors: Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Bronx, NY, USA. davilaluis1@yahoo.com
authors: Luis
authors: L
authors: Davila Santini
authors: Yana
authors: Y
authors: Etkin
authors: Adam J
authors: AJ
authors: Nadelson
authors: Toufic
authors: T
authors: Safa
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009518:New York; D011474:Prosthesis Design; D011859:Radiography; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency