The Role of Endovascular Stents in Dialysis Access Maintenance

Area of Science:

• Nephrology
• Interventional Radiology
• Vascular Surgery

Background:

• Vascular stenosis is a primary cause of hemodialysis vascular access dysfunction.
• Percutaneous transluminal angioplasty is the standard treatment, but stent use is increasing.
• Most stent applications in vascular access dysfunction are off-label, except for specific FDA-approved stent grafts.

Purpose of the Study:

• To review the current evidence for stent use in various conditions causing hemodialysis vascular access dysfunction.
• To evaluate the efficacy and limitations of stents in treating specific vascular access complications.
• To provide evidence-based recommendations for stent utilization in hemodialysis access.

Main Methods:

• Systematic review of published reports on stent use in hemodialysis vascular access dysfunction.
• Analysis of evidence supporting stent application in conditions like venous graft anastomosis stenosis, cephalic arch stenosis, and central venous stenosis.
• Evaluation of data regarding stent use in dialysis access aneurysms and device-induced stenosis.

Main Results:

• Stents show potential in treating diverse conditions including graft stenosis, cephalic arch stenosis, and thrombosed grafts.
• Specific contraindications exist, such as avoiding stents at cannulation sites and for aneurysm elimination.
• Kidney Disease Outcomes Quality Initiative guidelines recommend limiting stent use to specific scenarios like elastic lesions and recurrent stenosis.

Conclusions:

• Stent use in hemodialysis vascular access dysfunction is expanding, with varying levels of evidence.
• Clear recommendations exist against using stents at cannulation sites and for dialysis access aneurysms.
• Further research is necessary to solidify evidence for many stent applications in vascular access management.