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

Abstract

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.

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

“…This effect causes inhibition of smooth muscle cell proliferation and migration, resulting in reduction of neointimal hyperplasia. 16,17 No obvious neointimal hyperplasia ingrowth was found into DES in all patients that had 6-and 12-month follow-up angiogram that corresponding with the study of Dinh et al 13 that showed no significant neointimal hyperplasia at 6 months follow up by duplex ultrasound. The primary patency of DES at target lesion in this study was high; however, the primary patency rate of circuit was not significantly different before and after DES placements.…”

“…This study showed high primary patency rate of stent placement at target lesions 100% and 86% at 6 and 12 months, respectively, and significantly increased patency rate comparing with before stenting at target lesions. Our result showed a better primary patency of DES placement at the target lesion than a pilot study by Dinh et al, 13 which used DES in AVF, with result of 77.8% in 6-month primary patency of DES. However, the most common dialysis access in our study was AVG, whereas the study by Dinh et al 13 | 167 in dialysis access can provide mechanical support in the significant elastic recoil stenosis.…”

“…Our result showed a better primary patency of DES placement at the target lesion than a pilot study by Dinh et al, 13 which used DES in AVF, with result of 77.8% in 6-month primary patency of DES. However, the most common dialysis access in our study was AVG, whereas the study by Dinh et al 13 | 167 in dialysis access can provide mechanical support in the significant elastic recoil stenosis. Moreover, low dose of paclitaxel was absorbed into venous wall causing cell cycle arrest in the G1 phase.…”

“…11,12 To our knowledge and literature reviews, not enough pieces of evidence are reported to support the efficacy of DES for stenosis of hemodialysis access treatment in patients with end-stage renal disease. [13][14][15] This study aimed to report the 12month results of DES for the treatment of early significant restenosis of hemodialysis accesses.…”

Vasodilator agents improve hemodialysis vascular access patency

“…[ 9 ] To solve this problem, various interventional procedures, such as using drug-eluting balloons or stents, for reducing AV fistula stenosis are being performed; medical treatment for preventing stenosis and obstruction is also being considered. [ 17 – 19 ]…”