Abstract No. 207 Single-Institution Outcomes of Self-expanding PTFE-Covered Stents Throughout the Dialysis Circuit

Practice in the preservation of hemodialysis access points including fistulas and grafts has evolved to include placement of bare-metal, drug-eluting, and PTFE-covered stents. Randomized clinical IDE trials such as REVISE and RENOVA have investigated the outcomes of self-expanding covered stents focused specifically on the venous anastomotic segment. The purpose of this study is to present the patency outcomes of self-expanding stent use in the dialysis circuit not falling within the traditional IFU recommendations. Electronic medical records were reviewed to identify all self-expanding PTFE-covered stents (Viabahn, Gore; Newark, Delaware) placed in patients with hemodialysis access grafts and fistulas. Among these records, those with a first stent placed centrally to the access, at a point greater than 3 cm from the anastomosis, and at least 6 months of follow-up were further selected. Procedure reports and clinical notes were used to identify demographics, comorbidities, access type, stent location, patency, and reintervention rates. The total number of patients receiving PTFE-stents in the dialysis circuit was found to be 148, of those 46 patients (28F/18M) received primary stents greater than 3 cm from the anastomosis with follow-up at Rush. The average length of stents used ranged from 2.5 to 23 cm (average 7.72 cm). Primary patency at 180, 360, and 720 days were 35%, 20%, and 4% respectively with an average patency of 205 days. Treatment area primary patency was 49%, 29%, and 10%. Primary assisted patency was 51%, 37%, and 19% with an average time to failure of 366 days. The number of interventions needed at 6, 12, and 24 months were 1.10, 2.00, and 4.05 (Table 207.1). The use of self-expanding covered stent-grafts throughout the dialysis circuit at our institution has patency outcomes similar to the FDA approval studies with more restrictive placement parameters. Utilization of self-expanding covered stents throughout the circuit appears to be beneficial to improve overall access patency.