title: Salvage of angioplasty failures and complications in hemodialysis arteriovenous access using the FLUENCY Plus Stent Graft: technical and 180-day patency results.
abstract: OBJECTIVE
  To review technical and 180-day clinical outcomes when stent grafts were used to treat dysfunctional arteriovenous (AV) hemodialysis access circuits.
  
  
  METHODS
  The FLUENCY Plus Stent Graft (Bard Peripheral Vascular, Tempe, Arizona) was used to salvage percutaneous transluminal angioplasty (PTA) technical failures and complications in AV access circuits over 2 years. There were 106 patients treated with 138 stent grafts. Indications for stent graft use included residual stenosis after PTA (n = 81), extravasation after PTA (n = 22), early recurrent stenosis (n = 14), pseudoaneurysms (n = 4), and "other" (n = 4). Data were retrospectively analyzed for complications and outcomes.
  
  
  RESULTS
  Technical success was achieved in all patients, and clinical success was achieved in 104 (98%) of 106 patients. At 180 days, postintervention primary patency (PIPP) was 47%, and postintervention secondary patency (PISP) was 79%. PIPP was 62% for autogenous fistulas (AVFs) and 35% for prosthetic grafts (AVGs) (P = .010). The 180-day PIPP for stent grafts 9-10 mm in diameter was 63% versus 38% for stent grafts 6-8 mm in diameter (P = .012). Implants that did not cross the elbow had a 180-day PIPP of 47% compared with 25% for implants across the elbow (P = .032). Technical complications were periprocedure AVG thromboses (n = 2), intraprocedural stent graft dislodgment (n = 1), venospasm (n = 2), and contrast agent-related hives (n = 1). One patient returned at 2 months with an infected AVG and stent graft in the outflow vein.
  
  
  CONCLUSIONS
  The FLUENCY Plus Stent Graft was effective for maintenance of hemodialysis access circuit patency and was comparable or better than historical outcomes for PTA and bare stents. Factors that favored improved patency included larger diameter devices, use in AVFs, and avoiding placement across the elbow joint.
authors.affiliation: Department of Interventional Radiology, University of Texas Southwestern Medical Center, Physician Office Building #1, Suite 600, 5959 Harry Hines Boulevard, Dallas, TX 75390-8834, USA. Bart.dolmatch@utsouthwestern.edu
authors.forename: Bart L
authors.initials: BL
authors.lastname: Dolmatch
authors.forename: John M
authors.initials: JM
authors.lastname: Duch
authors.forename: Richard
authors.initials: R
authors.lastname: Winder
authors.forename: Gordon M
authors.initials: GM
authors.lastname: Butler
authors.forename: Michael
authors.initials: M
authors.lastname: Kershen
authors.forename: Rajankumar
authors.initials: R
authors.lastname: Patel
authors.forename: Clayton K
authors.initials: CK
authors.lastname: Trimmer
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Lopera
authors.forename: Ingemar J
authors.initials: IJ
authors.lastname: Davidson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000706:statistics & numerical data*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology