title: Endograft salvage of hemodialysis accesses threatened by pseudoaneurysms.
abstract: OBJECTIVE
  Currently, no formal practice guidelines exist regarding the use of endografts to exclude hemodialysis access pseudoaneurysms and prolong access lifespan in dialysis patients. We evaluated the efficacy of percutaneous endograft placement for exclusion of hemodialysis access pseudoaneurysms.
  
  
  METHODS
  Between July 2005 and October 2009, 32 patients were prospectively evaluated. Twenty-four patients were actively enrolled in the study based upon clinical and ultrasonographic evaluation of their hemodialysis accesses. Self-expanding covered endografts were placed percutaneously to exclude access pseudoaneurysms. Patients were evaluated at 2 and 6 months to assess for graft patency, access or outflow stenosis, endoleak, or stent graft migration.
  
  
  RESULTS
  No procedural complications resulted from these interventions. An average of 1.8 endografts was placed per patient, with patients requiring between 1 and 3 endografts to exclude pseudoaneurysms. Primary-assisted patency was 83% at completed 2-month follow-up and 54% at 6-month follow-up. At 12 months, primary-assisted patency was 50%. Eleven patients left the study before 6-month follow-up: five (21%) required explantation secondary to infection between 1 and 4 months; three (13%) were lost to follow-up; two (8%) died of unrelated causes; and 1 requested explantation citing pain from the "stent poking the vein." Mean time to explantation secondary to infection was 2.4 months. Mean duration of patency was 17.6 months with a range from 0 to 76 months. Mean duration of patency for patients who completed 6-month follow-up was 28.7 months. The longest duration of patency is 6 years 4 months, after stent fracture and subsequent placement of a new stent at 6 years 2 months. One other incident of stent fracture occurred at 36 months. Dialysis patterns were not interrupted in either patient.
  
  
  CONCLUSIONS
  The long-term results demonstrate that endograft salvage of failing hemodialysis accesses is a viable and safe alternative to open surgical revision that excludes pseudoaneurysms while maintaining uninterrupted access patency. A larger sample size and longer follow-up are needed to support the study data.
authors.affiliation: American University of the Caribbean School of Medicine, Sint Maarten. akinning@gmail.com
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Kinning
authors.forename: Russell W
authors.initials: RW
authors.lastname: Becker
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fortin
authors.forename: Robert G
authors.initials: RG
authors.lastname: Molnar
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Dall'Olmo
mesh_terms: D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012086:Reoperation; D016879:Salvage Therapy; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D055815:Young Adult