ABSTRACT
PURPOSE: To determine effectiveness of the VIABAHN (W.L. Gore & Associates, Flagstaff, Arizona) stent graft to treat cephalic arch stenosis in patients with dysfunctional brachiocephalic arteriovenous fistulas after inadequate venoplasty response. MATERIALS AND METHODS: Between 2012 and 2015, patients with failed venoplasty of symptomatic cephalic arch stenosis received a VIABAHN stent graft. Follow-up venography was performed at approximately 3, 6, and 12 months. Data were retrospectively analyzed with patency estimated using Kaplan-Meier and log-rank methodology. There were 39 patients included. RESULTS: Technical and clinical success was 100%. Primary target lesion patency was 85% (95% confidence interval [CI], 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency with regard to sex or age (P = .8 and P = .6, respectively). Primary assisted patency was 95% (95% CI, 82%-99%) at 3, 6, and 12 months. Access circuit primary patency was 85% (95% CI, 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency between patients with the stent graft as the first treatment episode in the cephalic arch and those that had previous intervention at this site (P = .98). There were 48 repeat venoplasty procedures performed in the cephalic arch to maintain patency, including 7 repeat VIABAHN insertions. No complications were encountered. CONCLUSIONS: The VIABAHN stent graft is a safe, effective, and durable device for treating cephalic arch stenosis when venoplasty fails.
Subject(s)
Arteriovenous Shunt, Surgical , Blood Vessel Prosthesis Implantation/methods , Brachiocephalic Trunk , Graft Occlusion, Vascular/surgery , Renal Dialysis , Stents , Adolescent , Adult , Aged , Blood Vessel Prosthesis , Female , Humans , Male , Middle Aged , Phlebography , Retrospective Studies , Treatment Outcome , Vascular PatencyABSTRACT
PURPOSE: To determine the effectiveness of stent-grafts for the treatment of central venous disease in hemodialysis patients with functioning arteriovenous (AV) fistulas. MATERIALS AND METHODS: Between October 2004 and March 2010, 42 VIABAHN stent-grafts were deployed in central veins of 30 patients (16 men, 14 women; mean age 60 y) with functioning AV fistulas and central venous disease that did not respond to percutaneous transluminal angioplasty (PTA). Eighteen patients had central vein stenosis and 12 had occlusion. Previous PTA and/or bare metal stent placement had been performed in 23 patients (77%). Surveillance was carried out at 3, 6, 9, 12, 18, and 24 months with diagnostic fistulography. The mean follow-up was 705 days (range, 66-1,645 d). Statistical analysis included Kaplan-Meier and log-rank studies. RESULTS: Technical success rate was 100%. Primary patency rates were 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively. Primary assisted patency rates were 100%, 100%, 80%, and 75% at 3, 6, 12, and 24 months, respectively. Patients without previous procedures had significantly shorter times to repeat intervention (P = .018) than those who had undergone PTA or bare metal stent placement previously. Patients with occlusive lesions had a significantly shorter primary patency interval (P = .05) than patients with stenoses. Occluded veins were more likely to require further stent-grafts (P = .02). Twelve patients required further stent-grafts to maintain patency. There was one minor complication. CONCLUSIONS: Stent-graft placement to treat central venous disease in hemodialysis patients with autogenous AV fistulas is safe and effective if PTA fails to maintain luminal patency.
Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Blood Vessel Prosthesis Implantation/methods , Catheterization, Central Venous/adverse effects , Renal Dialysis , Vascular Diseases/therapy , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Constriction, Pathologic , England , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Phlebography , Prosthesis Design , Retrospective Studies , Stents , Time Factors , Treatment Outcome , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiology , Vascular Diseases/physiopathology , Vascular Patency , Veins/physiopathologyABSTRACT
Extrarenal transplant pseudoaneurysms are rare, and treatment usually involves sacrificing of the transplant kidney. We report a case where combined use of a thrombotic agent and covered stents successfully excluded a pseudoaneurysm while preserving renal function.
