The Use of Supera Stents in Maintaining Dysfunctional Dialysis Arterioveonus Fistulas: A Single Center Experience

Background: Dialysis access failure is a major cause of mortality and morbidity among dialysis patients. Preservation of access is critical to maintaining hemodialysis, avoiding uremia, and managing the complications of kidney failure. The usual IR approach to thrombosed or stenosed arteriovenous fistula (AVF) is a combination of thrombectomy and balloon angioplasty of the underlying lesion. Stents and stent grafts appear to be an ideal method to treat thrombosis or neointimal hyperplastic stenosis. These safe endovascular device stents improving blood flow through the fistula or graft as they oppose elastic recoil and subsequent thrombosis. Stent placement is minimally invasive procedure, performed by IR doctors utilizing ultrasound and fluoroscopic guidance with rare complication and less stay in the hospital. The main indications of these procedure are early recurrent thrombosis, recoil stenosis and pseudoaneurysm of AVF. Method(s): This is a retrospective study of 11 consecutive patients (6 females) with mean age of 56 years, who underwent Supera stent placement for salvage of dialysis AVF between December 2016 to July 2018. Nine patients had brachiocephalic fistula and 2 patients had brachiobasilic fistula. Patients presented with fistula thrombosis (n=8) and dysfunction (n=3). Lesions were distributed along the venous outflow including the cephalic arch (n=5) and juxta-anastomotic needling segment (n=6). Evaluated outcomes included technical success, primary stent and circuit patency. Other outcomes were time to re-intervention and secondary patency. Result(s): Technical success was (100%). One stent stretched into the access sheath and was successfully removed through the puncture site, and a new stent was successfully deployed. Three patients required additional stent grafts at other sites during the index procedure. No major complications. Fistula function was restored in all patients with no additional interventions for a mean time of 242 days (50-734 days). Seven patients required re-intervention at mean time of 131 days (50-262 days). Reasons for re-interventions included inflow stenosis (n=5), outflow stenosis (n=1) and in-stent stenosis (n=1). Seven fistulas remain patent at mean follow up time of 484 days (136-734 days). Conclusion(s): Supera stent placement in AVF stenosis refractory to balloon angioplasty is technically feasible and may be effective in maintaining fistula function. Further evaluation of this technique requires larger randomized studies.

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Artikel online veröffentlicht:
11. Mai 2021