Related Experiment Video
Updated: Aug 9, 2025
Laparoscopic-Assisted Seldinger Technique for Peritoneal Dialysis Catheter Insertion
Published on: May 23, 2025
Bare-Metal Stent in Dysfunctional Hemodialysis Access: An Assessment of Circuit Patency according to Access Type and
Insights
Nitinol bare-metal stent placement in hemodialysis access shows better circuit patency with arteriovenous fistulas (AVF) compared to AV grafts (AVG). Stenting in the cephalic arch and graft-vein anastomosis is linked to lower patency rates.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Dysfunctional hemodialysis access frequently requires interventions to maintain patency.
- Nitinol bare-metal stents (BMS) are utilized to treat these stenotic lesions.
- Evaluating stent performance based on access type and location is crucial for optimizing outcomes.
Purpose of the Study:
- To assess circuit patency following nitinol BMS placement in hemodialysis access.
- To compare patency rates based on access type (AV fistula vs. AV graft).
- To determine the impact of stent location on circuit patency.
Main Methods:
- Retrospective analysis of 159 patients undergoing nitinol BMS placement between January 2017 and December 2019.
- Evaluation of circuit patency using Kaplan-Meier method and Cox regression.
- Categorization of stent locations including brachiocephalic vein, cephalic arch, upper arm vein, juxta-anastomotic vein, AV anastomosis, and graft-vein anastomosis.
Main Results:
- Overall, 159 stents were deployed in 103 AV fistulas (AVF) and 56 AV grafts (AVG).
- AVF demonstrated significantly higher 12-month primary (44.7% vs. 25.0%) and secondary (92.2% vs. 76.8%) patency compared to AVG.
- Poorer 12-month primary patency was observed for stents placed in the cephalic arch and graft-vein anastomosis.
Conclusions:
- Arteriovenous fistulas provide superior circuit patency compared to AV grafts after nitinol BMS placement.
- Stent placement in the cephalic arch and graft-vein anastomosis is associated with reduced primary patency.
- These findings highlight the importance of access type and specific anatomical locations in predicting BMS outcomes for hemodialysis access.
Purpose:
To evaluate the circuit patency after nitinol bare-metal stent (BMS) placement according to the type of access and location of the stent in dysfunctional hemodialysis access.
Materials And Methods:
Between January 2017 and December 2019, 159 patients (mean age, 64.1 ± 13.2 years) underwent nitinol BMS placement for dysfunctional access. The location of stents was as follows: 18 brachiocephalic vein, 51 cephalic arch, 40 upper arm vein, 10 juxta-anastomotic vein, 7 arteriovenous (AV) anastomosis, and 33 graft-vein (GV) anastomosis. Circuit patency was evaluated by the Kaplan-Meier method, and cox regression model.
Results:
A total of 159 stents were successfully deployed in 103 AV fistula (AVF) and 56 AV graft (AVG). AVG showed lower primary and secondary patency at 12-months compared with AVF (primary patency; 25.0% vs. 44.7%; p = 0.005, secondary patency; 76.8% vs. 92.2%; p = 0.014). Cox regression model demonstrated poorer primary patency at 12 months after stenting in the cephalic arch and GV anastomosis compared with the other sites.
Conclusion:
AVF showed better primary and secondary circuit patency at 12 months following the placement of BMS compared with AVG. Stents in the cephalic arch and GV anastomosis were associated with poorer primary patency at 12 months compared to those in other locations.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management