Stent Placement in Hemodialysis Access

Abstract

Vascular access stenosis in patients undergoing chronic hemodialysis is a major issue that is associated with increased morbidity, mortality, and cost of medical care. Recent data have emphasized that endovascular stents could be used in the treatment of central as well as peripheral stenotic lesions. In general, a peripheral or central vein lesion that is elastic or recurs within a three-month period after an initially successful balloon angioplasty or a stenosis where surgical revision is not possible are some indications for intravascular stent placement. Recent reports have expanded the role of stents in the management of pseudoaneurysms associated with dialysis access. In this context, the utilization of these devices must take into account a fair comparison with the traditional (surgical) approaches regarding effectiveness as well as costs. This report describes the role of stents in arteriovenous dialysis access. In addition, some of the recent advances in the structure and complicating issues such as stent fracture, migration, and infection, as well cannulation through the stent, are discussed.

Monocyte Chemoattractant Protein-1 Levels and Postangioplasty Restenosis of Arteriovenous Fistulas

“…The disparity may come from differences in pathology or therapy between atherosclerosis and dialysis AVFs. For example, stents were seldom used in dialysis AVFs but frequently used in arterial diseases (19). In animal studies, chemokine expression and leukocyte recruitment in response to balloon injury are less sustained than the response to stent injury (20).…”

Hemodialysis Catheter Malposition Induced by a Brachiocephalic Vein Stenosed Stent

“…4 Fibrosis of the venous endothelium, due to its contact with the catheter and catheter sheath formation, may lead to venous stenosis or occlusion. 5 The prevalence of stenosis following subclavian vein cannulation has been found in 40-50% of the cases and stenosis resulting from cannulation of internal jugular vein in 0-10% of the cases.…”

“…As more stents are placed, new and unusual complications are encountereddue to inadvertent migration and folding of a previously deployed subclavian stent, resulting from the attempt to place a dialysis catheter through the stented vessel. 4 For these reasons, the insertion of hemodialysis catheter through a stented vessel is gradually used more often. It would appear prudent that if such a combination is unavoidable, the catheter's tip should be placed either proximal of the stent or completely through it into the right atrium.…”

Guidelines for basic techniques in vascular access intervention therapy (VAIVT)

“…A self-expandable stent is commonly used at sites of flexion and access vessels that have different blood vessel diameters. 3,4,9,12,14,15,17,18,20,28,40,42,47,49,50,60,63,66,70,78 In the approach, as a 6Fr or larger sheath is required, a blood vessel that can accept that size sheath is also required. The venous approach is most common.…”