Intraoperative Stent Implantation for Venous Anastomotic Stenoses of Hemodialysis Grafts

Abstract

Ten filiform stenoses and 1 complete occlusion of the venous anastomoses of 11 hemodialysis grafts were diagnosed during operative revision for shunt thrombosis. After Fogarty balloon thrombectomy, the lesions were treated by intraoperative balloon angioplasty and stent implantation (IAS). All grafts could be used for hemodialysis immediately after IAS. The patients could be followed up for six to twelve months. Within 2 stents, restenoses causing rethromboses of the shunts occurred after three and seven months, respectively. In 1 case another intraoperative dilation was successful, and the other was treated by graft prolongation. All other stents were widely patent at the last examination as demonstrated by color duplex sonography. IAS proved an effective alternative to surgical revision of the stenosed anastomosis. It may be applied without difficulty to patients with multiple preceding revisions and provides excellent success rates.