Abstract
Vascular access stenosis is a major complication in hemodialysis patients. We prospectively observed 50 patients in whom 50 nitinol shape-memory alloy-recoverable technology (SMART) stents were used as salvage therapy for recurrent peripheral venous stenosis. Twenty-five stents each were deployed in native arteriovenous fistula (AVF) and synthetic arteriovenous polyurethane graft (AVG) cases. Vascular access patency rates were calculated by Kaplan-Meier analysis. The primary patency rates in AVF versus AVG at 3, 6, and 12 months were 80.3% versus 75.6%, 64.9% versus 28.3%, and 32.3% versus 18.9%, respectively. The secondary patency rates in AVF versus AVG at 3, 6, and 12 months were 88.5% versus 75.5%, 82.6% versus 61.8%, and 74.4% versus 61.8%, respectively. Although there were no statistically significant difference in patency between AVF and AVG, AVG showed poor tendency in primary and secondary patency. The usefulness of SMART stents was limited in a short period of time in hemodialysis patients with recurrent vascular access stenosis.
Highlights
Percutaneous transluminal angioplasty (PTA) is the standard for treatment of vascular access venous stenosis and occlusion since the 1980s [1], it carries a high rate of restenosis, and repeated endovascular intervention is often necessary
Twentyfive shape-memory alloyrecoverable technology (SMART) stents each were deployed in arteriovenous fistula (AVF) and arteriovenous grafts (AVG) cases
Stent location was significantly different between AVF and AVG cases because major stenotic lesions were located in the lower arm in AVF cases and in the upper arm in AVG cases
Summary
Percutaneous transluminal angioplasty (PTA) is the standard for treatment of vascular access venous stenosis and occlusion since the 1980s [1], it carries a high rate of restenosis, and repeated endovascular intervention is often necessary. The intervention rates for AVG are reported to be about five times higher than those for AVF, with patency rates less than 50% at 3 years [2]. To improve these statistics, various indications for the use of endovascular stents have been studied since 1989. Multiple studies have compared endovascular stents to PTA in terms of patency, but most of references reported limited or no advantages to a stent placement for peripheral venous and graft stenoses [2, 4, 9,10,11,12,13]. Cohort study conducted by Vogel and Parise reported that nitinol shape-memory alloyrecoverable technology (SMART) stents improved primary
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