Endovascular Stent Placement of Juxtaanastomotic Stenosis in Native Arteriovenous Fistula After Unsuccessful Balloon Angioplasty

Abstract

BackgroundIn hemodialysis patients, the most common problem in arteriovenous fistulas, as the best functional vascular access, is the juxtaanastomotic located lesions. Percutaneous transluminal angioplasty is accepted as the treatment method for juxtanastomotic lesions.ObjectivesTo assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction.Patients and MethodsBetween July 2003 and June 2010, 20 hemodialysis patients with autogenous radiocephalic or brachiocephalic fistula dysfunction underwent stent placement for the lesion located at the juxtaanastomotic region. Indications for stent placement were insufficient balloon dilatation, early recurring stenosis, chronic organizing thrombus and vessel rupture. The Kaplan-Meier method was used to calculate the stent patency rates. All patients who had fistula dysfunction (thrombosis of hemodialysis access, difficult access cannulation, extremity pain due to thrombosis or decreased arterial access blood flow) were evaluated by color Doppler ultrasound. The stenoses were initially dilated with standard noncompliant balloons (3 to 10-mm in diameter). Dilatation was followed by high pressure (Blue Max, Boston Scientific) or cutting balloons (Boston Scientific), if the standard balloon failed to dilate the stenotic segment.ResultsTwenty-one stents were applied. The anatomical and clinical success rate was 100%. Seventeen additional interventions were done for 11 (55%) patients due to stent thrombosis or stenosis during follow-up. Our 1- and 2-year secondary patency rates were 76.2% and 65.5%, respectively and were comparable to those after balloon angioplasty and surgical shunt revision.ConclusionMetallic stent placement is a safe and effective procedure for salvage of native hemodialysis fistula after unsuccessful balloon angioplasty.

Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up

“…It has been shown that the long-term clinical effects after endovascular treatment of obstructive AVF lesions have improved over the past years, and are parallel with our own observations [17,19,[25][26][27][28]. It may be related to the availability of low profile, high pressure balloons and growing experience of interventional teams.…”

Management of venous hypertension following arteriovenous fistula creation for hemodialysis access

“…in 2013 have used metallic stent to treat peripheral venous stenosis in 21 patients with peripheral venous stenosis with VH and demonstrated 1/2-year primary and secondary patency rates of 57.5/40.8% and 76.2%/65.5%, respectively, and these results were comparable to those after balloon angioplasty and surgical shunt revision. [ 7 ]…”

“…Transluminal angioplasty in the form of balloon dilatation (BD) and endovascular stent (EVS) is a safer alternative to surgery with an advantage of preservation of AVF, but still has unimpressive long-term patency rates. [ 2 3 4 5 6 7 ] When salvage options are exhausted, angiographic embolization of the AVF is another minimal invasive modality in the cases complicated by VH. [ 8 ] We present our experience in management of VH.…”

Imaging in Vascular Access

“…Transluminal angioplasty or endovascular stent positioning are a safer alternative to surgery with a higher chance of preserving the AVF, but still with an unimpressive long-term patency rates. 11 , 13 , 24 , 35 , 55 , 60 , 66 DSA offers a high performance in evaluating the severity of arterial stenoses but it is invasive and has a high risk of complication.…”