Venous stenoses in patients who undergo hemodialysis: treatment with self-expandable endovascular stents.

Abstract

During a 32-month period, 25 modified self-expandable endovascular stents were placed in 20 hemodialysis access sites to treat 21 stenoses and four occlusions in 19 patients. All stenoses were initially dilated with a high-pressure balloon. The initial success rate was 90% (18 of 20 access sites). The stents were patent from 0 to 960 days (mean duration of follow-up, 309 days). At 2 years follow-up, the patency rates were as follows: primary, 25%; secondary, 34%; and tertiary, 42%. The morbidity rate associated with this procedure was 15% (three of 20 sites); the mortality rate, 5% (one of 19 patients). All five complications (graft or native-vein thrombosis [n = 2], nerve deficits [n = 2], and death secondary to sepsis [n = 1]) occurred in three patients early in the study, before the use of prophylactic antibiotics and refinements in technique. The best results occurred in patients in whom the stenosis or occlusion affected a large vein that had no acute angle and was away from venous confluences such as the femoral and iliac regions.

Treatment of Hemodialysis-related Central Venous Stenosis or Occlusion: Results of Primary Wallstent Placement and Follow-up in 50 Patients

“…To avoid stent infection, stent placement should be delayed if there are signs of active infection in the patient. We did not administer prophylactic antibiotics during the procedure, and there were no cases of sepsis after deployment, such as were described by Quinn et al (29). There are no data to help prove that periprocedural application of heparin offers a substantial prolongation of acute patency after central venous stent implantation.…”

Interlocking Stents for Improving Stent Fixation at Graft–Venous Anastomosis

“…Zollikofer et al [8] treated 14 lesions with Wallstents, 12 of them still patent at 3-27 months (mean 19 months) at time of publication. At 2-year follow-up, Quinn et al [9] found patency rates as follows: primary, 25%; secondary, 34%; tertiary, 42%.…”

The Treatment of Chronic Hemodialysis Vascular Access by Directional Atherectomy

“…Although circumferential-tvpe stenosis frequently requires restenosis, the paten cy of vascular access is sufficiently long by repeated DA. Since the metallic stent technique has recently been applied to vascular access [17,18], insertion of the stent after DA might result in belter patency even if the stenotic lesion is the circumferential type. Schwab et al [19] reported that the early detection of lesions was of primary importance to ensure longer vascular access.…”