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Undersized stent graft for treatment of cephalic arch stenosis in arteriovenous hemodialysis access

Eric Po-Yu Huang1, Ming-Feng Li1,2,3, Chia-Chi Hsiao1,3

  • 1Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan, ROC.

Scientific Reports
|July 29, 2020
PubMed

Insights

Undersized stent grafts (SGs) improve hemodialysis access patency by reducing edge stenosis in cephalic arch stenosis (CAS) cases. This approach leads to better outcomes and fewer reinterventions compared to traditionally sized SGs.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Nephrology

Background:

  • Cephalic arch stenosis (CAS) frequently causes arteriovenous (AV) access failure in hemodialysis patients.
  • Conventional venoplasty has limited success for CAS, and stent grafts (SGs) can fail due to edge stenosis.

Purpose of the Study:

  • To evaluate the impact of stent graft (SG) diameter relative to cephalic vein size on patency rates in hemodialysis patients with CAS.
  • To determine if undersized SG placement affects outcomes in dysfunctional AV access.

Main Methods:

  • A retrospective study of 22 patients with CAS undergoing SG placement.
  • Patients were categorized into undersized (<1) and apposed (1-1.2) stent-to-vessel (S/V) diameter ratio groups.
  • Outcomes including patency rates and reinterventions were assessed via follow-up angiography.

Main Results:

  • Undersized SGs showed significantly smaller S/V ratios (p<0.001).
  • Placement of undersized SGs resulted in higher primary stent (p=0.001) and access patency rates (p=0.021).
  • Undersized SGs led to fewer post-treatment reinterventions per access year (p=0.021) and reduced lateral edge stenosis (p=0.005).

Conclusions:

  • Undersized SG placement is associated with superior primary stent and access patency rates.
  • This technique reduces the incidence of lateral edge stenosis and the need for reinterventions.
  • Undersized SGs are recommended for treating cephalic arch stenosis in hemodialysis access.

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