Stent grafts improved patency of ruptured hemodialysis vascular accesses

Area of Science:

• Interventional Nephrology
• Vascular Surgery
• Medical Device Technology

Background:

• Rupture of dialysis access during percutaneous transluminal angioplasty is a complication requiring effective management.
• Traditional methods like balloon tamponade have limitations in achieving long-term patency.
• Stent grafts offer a potential alternative for sealing these ruptures.

Purpose of the Study:

• To compare the efficacy of stent graft repair versus balloon tamponade for managing ruptured dialysis access.
• To evaluate target lesion primary patency and access circuit patency at 6 and 12 months post-intervention.

Main Methods:

• Retrospective analysis of 143 patients with ruptured dialysis access from 2010-2018.
• Comparison of outcomes between 52 patients treated with stent grafts and 91 patients treated with balloon tamponade.
• Primary endpoint: target lesion primary patency at 12 months.

Main Results:

• Stent graft group showed significantly higher 6-month (66.7% vs. 29.5%) and 12-month (52.5% vs. 9.0%) target lesion primary patency.
• Stent grafts increased median time to reintervention by 171 days (260 vs. 89 days).
• No significant difference in access circuit patency rates at 6 and 12 months between the groups.

Conclusions:

• Stent grafts provide superior target lesion primary patency for ruptured dialysis access compared to balloon tamponade.
• Stent graft repair is a durable solution that prolongs the time to subsequent interventions.
• While access circuit patency was similar, stent grafts offer a significant advantage in lesion-specific outcomes.