Effectiveness of Stent-graft Placement for Salvage of Dysfunctional Arteriovenous Hemodialysis Fistulas
Received 31 March 2009; received in revised form 26 November 2009; accepted 30 December 2009. published online 02 March 2010.
Purpose
To determine the clinical effectiveness of stent-graft placement in dysfunctional autogenous hemodialysis fistulas.
Materials and 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.
ABSTRACT