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.
