Results of drug‐eluting stent in significant restenosis of the hemodialysis access: An initial study

Abstract

Hemodialysis access dysfunction causes increased morbidity and mortality rate which affects the quality of life in patients undergoing hemodialysis. The most common cause of hemodialysis dysfunction is dialysis-related stenosis which may progress to access thrombosis. 1,2 The most common sites of stenosis of dialysis graft and fistula are venous anastomosis and juxta-anastomosis, respectively.The key treatment for hemodialysis access stenosis is the correction of underlying stenosis and maintenance of function as long as possible. Endovascular treatment of hemodialysis stenosis is a minimally invasive procedure with an effective outcome. 3 Transluminal conventional balloon angioplasty (CBA) is treatment of choice for hemodialysis-related stenosis. The outcome in terms of average cumulative patency rate at 6 and 12 months are 21%-61% and 17%-42%, respectively. 4,5 Recently, paclitaxel-coated balloon angioplasty (PCBA) is an advance technique that proved to prolong the patency rate of dialysis circuit. 6,7 However, this technique cannot be used in all cases, particularly in the case of immediate recoil stenosis.Currently, stenting is more commonly used in hemodialysis access. According to the Society of Interventional Radiology guideline, 3 indication of stenting in hemodialysis access includes failure balloon angioplasty and twice recurrent stenosis within 3 months after a previous angioplasty. In addition, venous rupture that cannot be controlled by low-pressure balloon tamponade and access pseudoaneurysm should be treated by stent graft. 3 The average primary patency rates of bare metal stent or stent graft in hemodialysis access stenosis at 6 and 12 months are 44%-73% and 21%-54%, respectively. [8][9][10] Although, the primary patency rate of stenting was higher than that of the CBA; however, this technique

Beyond the Veins: Uncovering the History and Advancements of Vascular Access

“…26–30 Drug-eluting stents have similarly been trialed in HD circuits with limited data showing some improved patency. 31…”

“…[26][27][28][29][30] Drug-eluting stents have similarly been trialed in HD circuits with limited data showing some improved patency. 31 Several devices for the percutaneous creation of AVFs have recently been approved. The Ellipsys vascular access device (Medtronic, Dublin, Ireland) creates an AVF between the proximal radial artery and deep communicating vein in the proximal forearm under ultrasound guidance, 32 whereas the Wavelinq endoAVF system (BD, Franklin Lakes, NJ) creates an AVF between adjacent radial or ulnar arteries and veins in the forearm using both ultrasound and fluoroscopic guidance.…”

Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single‐center experience

“…The patency rate in our study was also similar to that in previous studies, which ranged from 67% to 82% patency at 3 months. 11,12,16 To improve AVF patency, many devices, including drug-coated balloons, 17 covered stents, 18 and drug-eluting stents, 19 have been developed and published, but more evidence is still needed. In addition, this study also analyzed the risk factors associated with patency and showed that aneurysm size, the use of drugs, and comorbidities were not associated with patency.…”