Stenting in distal artero - venous fistolae Stenosis: preliminary reports

Abstract

Background: Transluminal percutaneus angioplasty (TPA) represent an effective surgical device to treat artero – venous fistulae (AVF) stenosis. TPA limit is represented by high rates of relapse. Stenting approach could represent right approach to bypass stenotic vessels. Scientific literature shows few references about stenting employment on artero – venous fistulae in end – stage kidney disease patients. Following data report our experience in patients with AVF stenosis. Patients and methods: We have selected six patients among 122 performed PTA (from April 2008 to December 2011) submitted to stenting practice with self – expandable metal stents. Patients selection criteria were following: vascular stenosis on post – anastomotic vein, second stenosis relapse after TPA and persistent stenosis after TPA with high pressures (untill 21 atmosphere). Among six patients, five of them had second relapse after PTA while last one presented single relapse with PTA resistant relapse. Results: Stenting was successful in all patients with no thrombotic events. Medium follow – up period was 21 + 10 months with overall observational period of 124 months. Two patients, respectively, died with working AVF after 13 and 26 months from stenting procedure. One patient developed a radial pre – anastomotic thrombosis across palmar arch. For whom to concern other three patients, one of them had no vascular troubles in next 21 months follow – up period. Last two patients developed vascular stenosis by neo – intimal intrastenting hyperplasia after 11 and 12 months respectively. Both patients were treated by TPA with complete recovery. After 12 and 13 months, respectively, intrastenting neo – intimal hyperplasia stenting was diagnosed again with consequent and successful TPA. Two patients with intrastenting relapse presented 15.1 + 0.9 months period free by any vascular accident such as thrombosis and/or stenosis. Conclusions: Altough we enrolled few patients, our preliminary experience showed stenting efficacy in treating vascular stenosis (100%). Potential neo – intimal hyperplasia force us to provide ultrasonographic stent survey, leading patients to TPA treatment. Due to optimal resolution by TPA, neo – intimal hyperplasia acquires secondary relevance. We think that stenting proceedings have to be further encouraged in selected patients.