Metallic Stent Placement in Hemodialysis Graft Patients after Insufficient Balloon Dilation

after Insufficient Balloon DilationObjective: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients.Materials and Methods: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation.The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients.Metallic stents 8 10mm in diameter and 40 80 mm in length were used.Of them, eight stents were deployed across the elbow crease.Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis.Results: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure.The overall primary and secondary patency rates ( standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69% 9 and 88% 6, 41% 10 and 88% 6, 30% 10 and 77% 10, and 12% 8 and 61% 13, respectively.For the forearm and upper-arm grafts, the primary and secondary patency rates were 51% 16 and 86% 13 vs 45% 15 and 73% 13 at 6 months, and 25% 15 and 71% 17 vs 23% 17 and 73% 13 at 12 months (p = .346and .224),respectively.Conclusion: Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation.No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.ercutaneous transluminal angioplasty (PTA) has become the first choice for treating most of the dysfunctional vascular access sites in hemodialysis patients.The technical success rate for PTA in the polytetrafluoethylene (PTFE) graft patients has been reported to be 75 94% (1 4).The randomized, prospective studies that have compared stents and angioplasty for treating dialysis graft vein stenosis have suggested that no benefit is gained by routine stent deployment (5, 6), but PTA alone was not considered appropriate to treat some types of vascular lesions that are seen in hemodialysis patients, including recoil or kinked stenosis (7 9) and venous rupture (10 12).The deployment of a metallic stent across the elbow crease has been reported on (13, 14) and different conclusions have been reached concerning the access patency for forearm and upperarm grafts (14, 15).