Peripheral stent placement in hemodialysis grafts

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Vascular access is crucial for hemodialysis patients.
• Balloon angioplasty is a common treatment for failing vascular access.
• Peripheral stent placement is an alternative when angioplasty fails.

Purpose of the Study:

• To evaluate the clinical outcomes of peripheral stent placement after failed balloon angioplasty in hemodialysis patients with grafts.
• To compare the efficacy of stent placement versus balloon angioplasty alone for maintaining vascular access patency.

Main Methods:

• Retrospective review of 267 balloon angioplasties in 71 hemodialysis patients (August 2000 - March 2007).
• Analysis of 30 Wallstents placed due to failed balloon angioplasty or early restenosis (<3 months).
• Evaluation of primary and secondary patency rates, clinical success, and reintervention rates.

Main Results:

• Clinical success rate for stent placement was 93.3%.
• 3-, 6-, and 12-month primary patency rates were 73.3%, 39.3%, and 17.7%, respectively.
• Stent placement prolonged primary patency after early restenosis compared to balloon angioplasty alone (P=0.0059), but primary patency was lower than successful balloon angioplasty (P=0.0279).
• Secondary patency rates were similar, but stent placement required more reinterventions (P=0.0419).

Conclusions:

• Peripheral stent placement is effective for salvaging vascular access after failed balloon angioplasty in hemodialysis patients.
• Stenting prolongs patency in cases of early restenosis following balloon angioplasty.
• Maintaining secondary patency with stents requires frequent reinterventions, and primary patency is lower than with balloon angioplasty alone.