Endovascular Stent Graft Repair is an Effective and Safe Alternative Therapy for Arteriovenous Graft Pseudoaneurysms

Wong, Weng Fai; Su, Ta‐Wei; Cheng, Wan-Chun; Yang, Hong-Tzer; Wei, Wen-Cheng; Ko, Po‐Jen

doi:10.1016/j.ejvs.2016.07.019

Cited by 14 publications

(15 citation statements)

References 28 publications

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“…In our experience, the Bard Lifestent ® (Bard Medical) can be difficult to puncture as it may collapse with needling. Covered selfexpanding stents in the AVF, which have been previously reported, 31 may protect against post-procedure limb bruising observed in this study. However, the optimal choice of stent is at present subject to further study.…”

Section: Discussionsupporting

confidence: 66%

“…Although AVF stent infection has been recorded in the literature, 33 these remain rarely reported, with emerging reports of successful use of stents for cannulation without a significantly increased risk of infection, stent fracture or protrusion through the skin. 31 The previously described use of plain balloon angioplasty and tributary ligation 9 may enlarge the conduit and thus facilitate access. The addition of a stent allows the resulting lumen to be scaffolded, which we have found improves the ability to palpate the conduit.…”

Section: Discussionmentioning

confidence: 99%

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Nitinol stent–assisted maturation of the dysfunctional cannulation zone in the immature arteriovenous fistula

et al. 2020

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Introduction: The native arteriovenous fistula may remain immature despite adequate arterial inflow after formation. This may occur when the puncturable vein segment (cannulation zone) is too small to be reliably punctured, occluded or too deep under the skin for needle access. We performed stenting (stent-assisted maturation) of arteriovenous fistulas with an immature cannulation zone, allowing for a large subcutaneous channel which could then be immediately punctured for dialysis. Methods: We performed a retrospective review of 49 patients (mean age was 58.7 ± 16.09 (12–83) years, mean arteriovenous fistula age of 162.6 ± 27.28 days) with end-stage renal failure who underwent balloon dilatation and bare-metal stent implantation (1.6 ± 0.67 (1–3) stents, median diameter and length of 8 (5–14) mm and 80 (40–150) mm, respectively) through their cannulation zone (forced maturation). Radiocephalic (35 arteriovenous fistulas), brachiocephalic (10 arteriovenous fistulas) and autogenous loop arteriovenous fistulas (4 arteriovenous fistulas) were included with 30 patients (61.2%) having an inadequate cannulation zone venous diameter, 9 patients (18.4%) having an absent cannulation zone and 10 patients (20.4%) having a patent cannulation zone deeper than 1 cm which was not reliably puncturable. The study was conducted over 9 years (January 2008–December 2016) with implantation of the SMART® stent and Absolute Pro® stent in 61.2% and 38.8%, respectively. Long-term outcomes including primary useable segmental and access circuit patency as well as assisted primary access circuit patency, rate of re-intervention, technical success and complications were analysed. Results: At 6 months, 12 months and 4 years, respectively, cannulation zone primary patency was 84.4%, 74.4% and 56.1% and access circuit primary patency was 62.2%, 45.3% and 23.2%; however, assisted primary access circuit patency was 95.6%, 91.1% and 83.8%, achieved with an endovascular re-intervention rate of 0.53 procedures/year with only four thrombosed circuits occurring. Discussion: Forced maturation using nitinol stents allows for long-term haemodialysis access with a low rate of re-intervention.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Nitinol stent–assisted maturation of the dysfunctional cannulation zone in the immature arteriovenous fistula

et al. 2020

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“…2,10 However, a high risk of thrombosis and infection has been reported in the covered stent grafts when used for exclusion of pseudoaneurysm especially in patients using prosthetic access grafts ranging from 11 to 35%. 4,14,15 The K-DOQI guidelines recommend open surgical repair with surgical resection and interposition graft especially when the pseudoaneurysm is infected, twice the diameter of the graft, threatens the overlying skin, or is rapidly increasing in size with signs of impending rupture. 7 Our focus in the current study was thus to determine the clinical safety and efficacy of endovascular stent graft repair in pseudoaneurysms with signs of infection and bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Though open surgical repair still remains the current standard of treatment as per the K-DOQI guidelines, recent literatures have focused on the clinical safety and efficacy of endovascular stent graft intervention for the management and exclusion of pseudoaneurysms complicating hemodialysis access. 2,[4][5][6] A recent study by Wong et al in 35 patients showed 100% technical success rate with 37 endovascular stent graft repairs to exclude AVG pseudoaneurysms.…”

Section: Introductionmentioning

confidence: 99%

Utilization of stent grafts in the management of arteriovenous access pseudoaneurysms

et al. 2017

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Objective Endovascular stent graft repair for exclusion of pseudoaneurysm is currently being explored to replace open surgical repair as current management. The objective of the study was to evaluate the clinical safety and efficacy of endovascular stent graft intervention in pseudoaneurysms complicating arteriovenous reconstructions in patients on chronic hemodialysis. Methods A retrospective analysis of all pseudoaneurysms treated with stent grafts at our institution over a period of five years was performed. The indications for endovascular intervention included bleeding from the pseudoaneurysm, infection, and significant skin compromise overlying the pseudoaneurysm or combination of the above. The rates of technical success, complication, and primary patency were measured at one-week, one-month, and six-month follow-up. Results A total of 33 endovascular stent graft interventions in 29 patients were performed for the treatment of pseudoaneurysms. The average age of patients was 68 years (range 31-90 years), with 13 female. Diabetes and hypertension were present in 15 and 22 patients, respectively. In eight patients, there was evidence of active infection at the fistula site. The choice of stent grafts include Viabahn ( n = 31), Wallgraft ( n = 1), and i-Cast ( n = 1). The initial technical success rate was 94%. The two failed interventions included occlusion of inflow artery with immediate conversion to open procedure ( n = 1) and incomplete pseudoaneurysm exclusion ( n = 1). Primary patency at one month and six months was 83 and 60%, respectively. An additional balloon angioplasty of outflow tract or central stenosis was performed in 18 cases (54%). The explanation of stent grafts due to persistent or recurrent bacteremia/site infection was required in four out of eight patients. The average time to explanation was 93 days (range 6-204 days). Conclusion The stent graft implantation is a safe, minimally invasive and efficient way to control and manage arteriovenous accesses with pseudoaneurysms. In the presence of infection, this approach may be less durable.

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“…Which one of the following interventions below is most appropriate? 3 A. Immediate ligation of the arteriovenous graft with concurrent tunneled dialysis catheter insertion with a schedule of new access creation 6 weeks later.…”

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confidence: 99%

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2017

European Journal of Vascular and Endovascular Surgery

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In order to detect spiral laminar flow on duplex: 1 A. The artery must be imaged in a true transverse plane with a lower frequency range (0.05m/se 0.2m/s) B. The artery must be imaged in a true longitudinal plane with a lower frequency range (0.05m/s e 0.2m/s) C. The artery must be imaged at a site of arterial bifurcation D. The artery must be imaged in a true transverse plane with a normal frequency range for detecting laminar flow (dependent on artery being imaged) E. The artery must be imaged in a true longitudinal plane with a normal frequency range for detecting laminar flow (dependent on artery being imaged) 2. Which ONE of the following statements is correct regarding patient-specific material properties of the AAA wall? 2 A. The material properties represent the amount of strain in the AAA wall B. The material properties represent the amount of stress in the AAA wall C. The material properties can only be determined ex-vivo, using either (bi-axial) tensile testing or inflation testing D. The material properties represent the elasticity or stiffness of the AAA wall E. The material properties represent the calcification within the AAA wall

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Endovascular Stent Graft Repair is an Effective and Safe Alternative Therapy for Arteriovenous Graft Pseudoaneurysms

Abstract: The study demonstrates that endovascular stent graft repair is an effective and safe alternative therapy for AVG pseudoaneurysms. However, the rate of thrombosis and infection was high and needs to be balanced against open surgery in future studies.

Cited by 14 publications

References 28 publications

Nitinol stent–assisted maturation of the dysfunctional cannulation zone in the immature arteriovenous fistula

Nitinol stent–assisted maturation of the dysfunctional cannulation zone in the immature arteriovenous fistula

Utilization of stent grafts in the management of arteriovenous access pseudoaneurysms

One year on: Test your knowledge from the previous year

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