December 22, 2008

Utility of Viabahn® Stent-Grafts in Improving the Secondary Patency of Hemodialysis Arteriovenous Grafts

Luis R. Davila-Santini, MD, Feng Qin, MD, Kambhampaty V. Krishnasastry, MD, Toufic K. Safa, MD.
North Shore-LIJ Health System, New York, NY, USA.

Objective: Failing hemodialysis grafts continue to pose a challenge in the care of patients with end stage renal disease. This is a review of our initial experience utilizing percutaneous Viabahn® stent-grafts in the treatment of venous outflow stenoses or obstruction, in order to assess their efficacy in graft salvage.
Materials and Methods: We retrospectively reviewed our data for all patients who underwent percutaneous stent-grafting for venous outflow stenoses or obstruction on failing hemodialysis arteriovenous(AV) grafts, between 6/2006 and 8/2008. Demographic data, secondary patency and re-intervention rates are reported. All the stent-grafts were performed with the Viabahn® prosthesis (WL Gore, Flagstaff, Az, USA). All stent-grafts were deployed across the venous anastomosis to address the outflow obstruction.
Results: Seventeen patients had stent-grafts placed. Fourteen patients had forearm non-autologous AV grafts and 3 patients had femoral non-autologous AV grafts. Successful stent-grafting was defined as <30% residual stenosis and ability to dialyze through the graft post treatment. Technical success for stent-grafting was 100%. A single stent was placed in 16/17 (94%) procedures. One patient required placement of 3 stents. Fifteen of 17 (88%) grafts had already undergone balloon angioplasty as a separate procedure within the past 12 months prior to the stent-graft placement. Median follow-up was 11 months (range 1-26 months). Secondary patency at 1 month was 100%(17/17), 6 months 88%(15/17), 12 months 88%(15/17) and 24 months 76%(13/17). Two of 17 patients (12%) required re-intervention for arterial inflow stenosis within 6 months of stent-graft placement. One patient (6%) occluded the AV graft after 3 months and required a new access site. One patient (6%) required balloon angioplasty and stenting of the vein for a stenosis distal to the stent-graft. None of the other AV grafts was lost during the follow-up period.
Conclusions: Improved secondary patency rates as well as freedom from re-intervention rates can be achieved using stent-grafts for venous outflow stenoses or obstruction. Stent-grafts remained patent, even in the presence of arterial inflow stenosis.

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