Venous stenoses in dialysis shunts: treatment with self-expanding metallic stents.

Abstract

A flexible, self-expanding metallic endoprosthesis was employed for the treatment of venous outflow stenoses in four patients with a polytetrafluoroethylene shunt and two patients with a Brescia-Cimino shunt. The stenoses had led to shunt occlusion in five patients and to flow impairment in one. In the occluded shunts, thrombectomy and subsequent balloon angioplasty were performed in four patients, and percutaneous recanalization with angioplasty was performed in one. One shunt with decreasing flow was percutaneously dilated. Since the underlying stenoses recurred in four patients after 24 hours and did not respond sufficiently to angioplasty in two patients, up to four stents were placed in the venous segments. Thrombosis of the stents occurred in two patients after 24 hours and in one after 6 weeks and was successfully recanalized with thrombectomy in two. At 2-6 months follow-up, the stents and the shunts were patent in five patients. In three of these patients, intima hyperplasia, associated with narrowing of the stent lumen in two, was noted within 4 months after stent placement.