Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis

Swinnen, John; Tan, Kia Lean; Allen, Richard D.; Burgess, David; Mohan, Irwin V.

doi:10.1016/j.jvs.2014.05.097

Cited by 25 publications

(18 citation statements)

References 18 publications

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“…A significant stenosis was defined as a luminal diameter of <2.7 mm during B-mode and color duplex imaging. Swinnen et al [3] previously verified this criterion. In addition, secondary endpoints included access circuit patency, assisted primary patency, and secondary patency.…”

Section: Methodsmentioning

confidence: 80%

“…With superior patency and lower reintervention rates, the autogenous arteriovenous fistula (AVF) is the preferred form of vascular access [1,2]. However, AVF is prone to restenosis [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Percutaneous transluminal angioplasty (PTA) is increasingly being accepted as the first-line treatment for restoring luminal diameter [1]. However, PTA has variable technical success rates and high rates of restenosis [3,4,8]. Drug-eluting balloons (DEBs) have been shown to improve patency, particularly in recurrent stenosis [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study

Dinh

Thomas

Cho

et al. 2019

VSI

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PurposeWe report short-term patency outcomes of a proof of concept study conducted to determine the efficacy of drug-eluting stent (DES) for the treatment of arteriovenous fistula (AVF) stenosis in hemodialysis patients.Materials and MethodsThis is a single-center, retrospective observational study involving 10 patients with AVF dysfunction treated with DESs between January 2017 and December 2017. The primary outcome was AVF patency confirmed by sonographic and clinical assessment at 1 month and 6 to 9 months after treatment.ResultsA total of 12 DESs were deployed in 10 patients with dysfunctional AVF (radiocephalic: 7, brachiocephalic: 3). During the early follow up (mean: 28.6 days), primary access circuit and DES patency was 100%, with an average volume flow rate of 886.4 mL/min. Nine patients were available for short-term follow up (mean: 202.4 days; 1 unrelated death), with a mean volume flow rate of 1,048.9 mL/min. The primary DES patency was 7/9 (77.8%), and 3 patients required angioplasty at other parts of the circuit (primary access circuit patency: 4/9 [44.4%]). The assisted primary access circuit patency was 77.8%. In 2 patients, the ultrasound revealed that the DESs were thrombosed without any antecedent stenosis; they were salvaged with angioplasty. Both patients previously underwent 2 DESs implanted and recently stopped dual antiplatelet therapy. B-mode sonographic assessment at all timepoints showed minimal intimal ingrowth on the stent struts.ConclusionThis study demonstrates acceptable short-term patency for DESs in the treatment of AVF stenosis. Dual antiplatelet therapy is probably mandatory in the short term.

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Section: Methodsmentioning

confidence: 80%

“…With superior patency and lower reintervention rates, the autogenous arteriovenous fistula (AVF) is the preferred form of vascular access [1,2]. However, AVF is prone to restenosis [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study

Dinh

Thomas

Cho

et al. 2019

VSI

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“…The use of a nitinol stent is critical to the success of this procedure. 29 The stent prevents elastic recoil of the vein initially, thus preserving the fistula as a low-pressure circuit. The stent also serves as a scaffold for new intimal tissue formation which thus seals the stent to prevent haemorrhage in the event of outflow stenosis.…”

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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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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“…We make liberal use of bare Nitinol stents to support this aggressive angioplasty. 10 The DEB and Sham balloon differed in only two respects ( Figure 1). The DEB had a Paclitaxel coating, and it was 1 cm longer at either end than the Sham balloon.…”

Section: Trial Operation Protocolmentioning

confidence: 99%

Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses

et al. 2018

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Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis

Abstract: JXAS is an effective technique for maturing and maintaining the wrist radiocephalic arteriovenous fistula.

Cited by 25 publications

References 18 publications

Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study

Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study

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

Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses

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