Endovascular techniques used to exclude dialysis access pseudoaneurysms and erosions

OBJECTIVES: To see if covered stents could be used to safely exclude dialysis access pseudoaneurysms and erosions.
METHODS: All procedures were performed by a vascular surgeon skilled in endovascular techniques in an angiography suite using conscious sedation and local anesthetic. A micropuncture sheath was placed using the Seldinger technique and a diagnostic fistulogram was obtained. The pt was anticoagulated using intravenous heparin at the interventionalist’s discretion. Fluency self-expanding covered stents were deployed using a bare back technique. Subsequently, a 6 french sheath was placed after the stent deployment. Additional angioplasty was performed as needed. Duplex ultrasound studies were performed at two and six month post operative intervals.
RESULTS: From July 2005 to August 2007, we prospectively evaluated 19 pts of which 11 were actively enrolled. Ten pts had multiple PAs. Nine had previous interventions consisting of angioplasty of stenotic areas. Additional angioplasty was performed 64% (7/11) at the time of covered stent placement. There were no complications from the PA exclusions. Two month follow up duplex was completed on 90% (10/11) pts and six month duplex was completed 55% (6/11). One pt had explantation of the stent before 2 month duplex. One pt died before completing 6 month follow up. One pt has not been enrolled for 6 months. Two pts have had stent removed due to infection before 6 month follow up. Two and six month duplex showed 100% patency and effective exclusion of PAs.
CONCLUSIONS:Our results to date show that minimally invasive endovascular techniques can be used safely to successfully exclude PAs while prolonging the use of the HD access. A larger sample size and follow up is needed to validate and support our current results.