Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients.
OBJECTIVE
The study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.


METHODS
63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5%), followed by complications of angioplasty with vessel rupture or dissection (31.8%).


RESULTS
A high rate of procedural success was achieved (98.5%). The most frequent location of the deployed stent-graft was the draining vein (66.7%). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5% at 6 month, 31.3% at 12 month and 19.2% at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1%), followed by stenosis at the AV access (29.5%) and the deployed stent-graft (23.5%).


CONCLUSIONS
Re-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.
Department of Diagnostic and Interventional Radiology, Klinikum Ingolstadt, Krumenauerstraße 25, 85049, Ingolstadt, Germany, christopher.schmelter@klinikum-ingolstadt.de.
Christopher
C
Schmelter
Udo
U
Raab
Friedrich
F
Lazarus
Volker
V
Ruppert
Dierk
D
Vorwerk
D000368:Aged; D017130:Angioplasty; D001164:Arteriovenous Fistula / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003251:Constriction, Pathologic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D015641:Radiography, Interventional; D006435:Renal Dialysis; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology