The role of stents in hemodialysis vascular access

Area of Science:

• Nephrology and Vascular Surgery
• Dialysis Vascular Access Management
• Interventional Radiology

Background:

• Vascular access complications, particularly neointimal hyperplasia and stenosis, significantly impact dialysis therapy for end-stage kidney disease (ESKD) patients.
• Traditional percutaneous transluminal angioplasty (PTA) using balloon inflation has shown suboptimal patency rates for these stenotic lesions.
• The limitations of balloon angioplasty necessitate the exploration of advanced interventions to enhance vascular access functionality.

Purpose of the Study:

• To review the existing literature on the efficacy of stents in managing stenotic lesions within dialysis vascular access.
• To analyze major clinical trials evaluating stent use across various anatomical locations and clinical scenarios in dialysis patients.
• To provide an overview of current evidence regarding stent-based interventions for dialysis vascular access stenosis.

Main Methods:

• Comprehensive literature search of available studies on stent utilization for dialysis vascular access stenosis.
• Review and synthesis of data from major clinical trials focusing on different stent types and applications.
• Analysis of outcomes related to vascular access patency and clinical efficacy in diverse patient populations.

Main Results:

• Stent-based interventions have emerged as a significant advancement over traditional balloon angioplasty for treating dialysis vascular access stenosis.
• Evidence from clinical trials suggests improved patency rates and functional outcomes with stent use in various anatomical locations.
• The effectiveness of stents may vary depending on the specific type of stent, lesion characteristics, and clinical context.

Conclusions:

• Stent placement represents a valuable therapeutic option for managing neointimal hyperplasia and stenosis in dialysis vascular access.
• Further research and comparative studies are warranted to optimize stent selection and application strategies for improved long-term outcomes.
• Stents hold the potential to significantly enhance the durability and functionality of vascular access, thereby improving the quality of life for dialysis patients.