Treatment of intragraft stenosis in hemodialysis grafts with Supera stents: A retrospective study

Abstract

Purpose: To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses. Methods: Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3 months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded. Results: The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6–36) months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12 months, respectively. Access circuit secondary patency rates were 100% at 6 and 12 months and 89% at 18 months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6 months and 75% at 12 months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation. Conclusion: The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.

SUPERA stent placement for salvaging early recurrent arteriovenous graft thrombosis after percutaneous transluminal angioplasty: A single-center study

“…Recent data from the SUPERA stent insertion into intra-graft stenosis in the AV graft have shown promising patency. 24 Since this study is a single-institution retrospective design, there are limitations in interpreting the usefulness of the SUPERA stent for AV graft. Also, our study does not include comparative group such as PTA or SG.…”

“…The exhausted AV graft, particularly when the needling area cannot be executed in various locations, has abundant peri-graft scar formation due to repetitive punctures and is often discolored, with pseudointima growing within the graft. 2,24 Corresponding lesions may not be resolved even with balloon angioplasty alone. In addition, in massive intimal growth in the GV anastomosis, elastic recoil occurs despite full-effacement of the balloon.…”