A Practical Review of the Use of Stents for the Maintenance of Hemodialysis Access

Conclusion In the last two decades, there has been a dramatic increase in stent placement for dialysis access venous stenosis, in-stent stenosis, aneurysms and pseudoaneuryms, and angioplasty-induced vascular rupture. At this point, there is level 1 evidence for SG superiority over PTA for venous stenosis in AV grafts and in-stent stenosis in both AV grafts and AV fistulae. Given significant updates in evidence for stent use and considerable advancement in stent technology, we feel that an update of KDOQI clinical practice guidelines, which have not been revised in over 8 years, is in order. Although recent data for stent use in AV fistula lesions are promising, at present, we do not routinely deploy stents in this setting as a primary treatment. Until further large prospective, randomized controlled trials are conducted to assess primary stenting of venous stenosis in the setting of AV fistulas, our preference remains PTA as a primary treatment for AV fistula dysfunction.