AVA 1. Salvage of Failing Native Arteriovenous Fistula by Interwoven Nitinol Stenting: A Review of Early Experience

Abstract

Percutaneous angioplasty remains the most commonly employed method for treatment of native arteriovenous access stenosis. There is growing evidence that demonstrates benefit with covered stenting of recalcitrant stenosis in patients with an arteriovenous graft. Currently, the use of either bare-metal stents or covered stents in patients with native arteriovenous fistulas (AVFs) is not considered a first-line intervention. This case series aimed to examine the clinical effectiveness and feasibility of interwoven nitinol stenting in the salvage of failing AVFs. A prospective analysis was conducted of five patients who underwent interwoven nitinol stenting as a final salvage intervention for their failing AVFs. Clinical surveillance was performed with dialysis flow sheets; radiology surveillance was performed with duplex ultrasound at 6 weeks and 6 months. All patients were male, with a mean age of 67 years. The average AVF age was 17.6 months (range, 7-35 months); the average number of prior interventions was 1.4 fistuloplasties per patient. Fistuloplasty and stenting were performed as a final salvage procedure. Technical success rate was 100% with no complications. All patients were observed in the outpatient clinic 6 weeks after stenting. There was an average positive improvement in access flow rate of 209 mL/min, with average access flow rates of 154 mL/min before stenting and 359.1 mL/min after stenting (P = .059). Primary patency at 6 months and 12 months was 100%. Dialysis nurses were able to cannulate through the stents, and there was no occurrence of stent ulceration. Based on our initial experience, treatment of recurrent stenotic AVF with interwoven nitinol stenting is a safe and effective method of salvaging failing AVFs.