3:20 PM Abstract No. 233 Severe arm swelling in hemodialysis patients with an arteriovenous access and ipsilateral central vein stenosis: comparison of stent deployment versus conversion to a HeRO graft

Abstract

In ESRD patients with indwelling arteriovenous (AV) fistulas or grafts, central venous stenosis can result in massive arm swelling. For angioplasty-resistant lesions, treatment options include stent deployment, conversion to HeRO graft, and access ligation. While stent deployment is the least invasive option, stents have the potential to limit access options on the ipsilateral or contralateral side. The purpose of this study was to compare clinical outcomes in patients with severe arm swelling due to a central vein stenosis ipsilateral to AV fistula or graft treated with stent deployment versus access conversion to a HeRO graft. This retrospective study was performed on 52 patients (19 males, 32 females, mean age 56.6) with severe arm swelling ipsilateral to an AV access and a central vein stenosis. Of these, 29 patients underwent central venous stent deployment and 23 underwent placement of a HeRO graft with anastomosis directly to the existing graft or fistula. Symptomatic improvement in arm swelling, and primary and secondary access patency were ascertained from medical records. Categorical and continuous variables were compared with the chi square and t-test respectively. Patency rates were calculated with the Kaplan-Meier technique and compared with the log rank test. The two groups were not significantly different with regard to gender (p = 0.78), age (p = 0.61), side of AV access (p = 1.0), fistula versus graft (p = 0.56), or age of access (p = 0.45). Improvement in swelling was found in 86% and 95% after stent deployment or HeRO conversion within 1 month, respectively (p = 0.55). The median primary patency was significantly longer for HeRO conversions than stent deployments (18.9 vs 5.4 months, p<0.001). HeRO conversions also resulted in longer secondary patency (105.2 vs 29.4 months, p = 0.005). The mean number of interventions to maintain secondary patency was 2.7 per 1000 access days for HeRO conversions and 6.3 per 1000 access days for stent deployments. In patients with severe arm swelling due to a central venous stenosis ipsilateral to an AV access, conversion of the access to a HeRO graft resulted in significantly longer primary and secondary patency rates than stent deployment.