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Stent graft for nephrologists: concerns and consensus
1Division of Nephrology, Section of Interventional Nephrology, University of Miami Miller School of Medicine, 1600 NW 10th Avenue (R 7168), Miami, FL 33136, USA.
Summary
Stent grafts are increasingly used for dialysis access complications like stenosis and pseudoaneurysms. While approved for some uses, their effectiveness and cost-benefit for other conditions remain debated, requiring nephrologist evaluation.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Devices
Background:
- Stent grafts are emerging as a treatment for arteriovenous dialysis access complications.
- Common applications include vein-graft anastomotic stenosis, pseudoaneurysm formation, and cephalic arch stenosis.
Purpose of the Study:
- To provide an up-to-date synopsis on stent graft use in dialysis access management.
- To assist nephrologists in evaluating the appropriateness of stent grafts for vascular access dysfunction.
Main Methods:
- Review of current literature and clinical trial data.
- Analysis of Food and Drug Administration (FDA) approvals and guidelines.
- Discussion of controversies and consensus regarding stent graft application.
Main Results:
- A randomized trial led to FDA approval for stent grafts in vein-graft anastomotic stenosis.
- Controversies persist regarding stent graft use for stenosis and pseudoaneurysms.
- Stent grafts are unequivocally indicated for angioplasty-induced complete vascular rupture.
Conclusions:
- Nephrologists must be familiar with the evolving role and controversies of stent grafts in dialysis access.
- A cost-benefit analysis is warranted for stent graft procedures.
- Stent graft use is anticipated to increase, necessitating informed clinical decision-making.
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