Abstract No. 18 - Bare metal versus covered stents for treatment of intragraft stenosis within prosthetic hemodialysis arteriovenous grafts

Abstract

Angioplasty is the standard method for treatment of intragraft stenosis within prosthetic hemodialysis grafts. While stenting can be performed, there are no comparative data in the literature on various stent types at this location. Therefore, the purpose of this study was to compare post-intervention access patency rates after deployment of bare metal versus covered stents for the treatment of intragraft stenoses. Our procedural database was retrospectively reviewed for all percutaneous interventions on prosthetic hemodialysis grafts over a 7-year period in which a stent was deployed at the site of an intragraft stenosis. 31 stent deployments within 22 patients were identified (15 males, 7 females, mean age 57.4 years). All stents were deployed due to suboptimal results with angioplasty (“bail-out”). Intragraft stents deployed for the treatment of anastomotic stenosis, pseudoaneurysms, or bleeding were excluded. Post-intervention access patencies were calculated using Kaplan-Meier analysis and compared using the logrank test. 21 covered stents and 10 bare metal stents were deployed for the treatment of intragraft stenoses. 90% of the grafts were thrombosed at presentation. The 3 and 6 month post-intervention primary access patency rates for bare metal stents were not significantly different from covered stents: 44% and 22% compared to 45% and 25%, respectively (p=0.92). The 6 and 12 month post-intervention secondary access patency rates were also not significantly different: 50% and 30% for bare metal stents and 80% and 55% for covered stents (p=0.28). The 6 month lesion patency rate was 56% and 70%, respectively (p=0.45). In this retrospective study with limited sample size, bare metal and covered stents deployed to treat intragraft stenosis resistant to angioplasty demonstrated similar primary, secondary, and lesion patency rates.