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Published on: May 31, 2022
The Role of Covered Stents in Hemodialysis Access: Experience From a Vascular Access Centre
Andreia Henriques1,2, João Venda1, Emanuel Ferreira1,2
1Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT.
Insights
Covered stents (CSs) for hemodialysis vascular access may delay reinterventions but do not reduce their frequency. Patient selection is crucial for optimal outcomes with CSs in hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Vascular access (VA) dysfunction is a major complication in hemodialysis (HD).
- Percutaneous transluminal angioplasty is common, but covered stents (CSs) offer an alternative.
- This study assesses the role of CSs in managing VA dysfunction.
Purpose of the Study:
- To evaluate the efficacy of covered stents (CSs) in reducing reinterventions for hemodialysis vascular access.
- To compare the number and timing of procedures before and after CS placement.
- To assess factors influencing patency rates after CS implantation.
Main Methods:
- Retrospective study of patients receiving their first CS placement for AVFs and AVGs (2017-2022).
- Primary outcome: comparison of procedures in the 12 months pre- and post-CS placement.
- Secondary outcomes: primary patency (PP), assisted primary patency (APP), and secondary patency (SP).
Main Results:
- Eleven patients included; mean age 74.6 years.
- Mean interventions pre-CS (1.73) and post-CS (1.64) were similar (p=0.85).
- Mean time to reintervention increased significantly after CS placement (6.22 vs. 2.63 months).
- Primary patency was higher in arteriovenous fistulas (AVFs) than arteriovenous grafts (AVGs).
Conclusions:
- Covered stents may delay, but not significantly reduce, the frequency of reinterventions for hemodialysis vascular access.
- CSs did not improve overall vascular access survival in this cohort.
- Case-by-case decision-making and careful patient selection are essential for CS use.
Abstract:
Background Vascular access (VA) dysfunction in hemodialysis (HD) significantly impacts patient outcomes. While percutaneous transluminal angioplasty remains the primary intervention, covered stents (CSs) have emerged as a valuable adjunct. This study evaluates the efficacy of CS in reducing reinterventions and delaying subsequent procedures. Methods This retrospective study included patients who underwent their first CS placement at the SANFIL Vascular Access Centre between 2017 and 2022, involving arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). The primary outcome was a comparison of the number of procedures 12 months before and after CS placement. Secondary outcomes assessed primary patency (PP), assisted primary patency (APP), secondary patency (SP), and factors influencing these outcomes. Results Eleven patients were included, 72.7% male, with a mean age of 74.6 ± 8.8 years. Seven (63.6%) patients had an AVF. In the 12 months after CS placement, only two VAs did not require reintervention, while the remaining nine exhibited CS-related dysfunctions. The mean number of interventions in the 12 months before and after CS placement was similar (1.73 ± 1.01 and 1.64 ± 1.63, respectively; p = 0.85). However, the mean time to reintervention after CS placement was longer than the previous intervention: 6.22 ± 3.67 and 2.63 ± 2.60 months, respectively. PP was significantly higher in AVFs than in AVGs. Conclusions CS placement may delay the need for subsequent interventions, but it does not significantly reduce the frequency of procedures or improve overall VA survival. The decision to deploy a CS should be made on a case-by-case basis, particularly for patients with limited vascular options or those who are unable to undergo additional surgical procedures. Careful patient selection is essential to ensure the optimal use of CS in HD patients.
