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Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation.

Liang HL, Pan HB, Lin YH, Chen CY, Chung HM, Wu TH, Chou KJ, Lai PH, Yang CF - Korean J Radiol (2006 Apr-Jun)

Bottom Line: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure.For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively.No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

ABSTRACT

Objective: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients.

Materials and methods: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10 mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis.

Results: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (+/-standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%+/-9 and 88%+/-6, 41%+/-10 and 88%+/-6, 30%+/-10 and 77%+/-10, and 12%+/-8 and 61%+/-13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively.

Conclusion: Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

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Related in: MedlinePlus

A 51-year-old female patient with a thrombosed straight graft over her right upper arm.A. A large pseudoaneurysm at the venous anastomosis after PTA was noted, which failed to response to the prolonged balloon inflation.B. After a nitinol Memotherm stent (8×40 mm) was placed and one session of balloon inflation (5 min), small residual contrast extravasation (arrows) was still noted.C. With a second balloon inflation in the stent for another 5 min, the follow-up venogram showed complete exclusion of the pseudoaneurysm.
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Figure 2: A 51-year-old female patient with a thrombosed straight graft over her right upper arm.A. A large pseudoaneurysm at the venous anastomosis after PTA was noted, which failed to response to the prolonged balloon inflation.B. After a nitinol Memotherm stent (8×40 mm) was placed and one session of balloon inflation (5 min), small residual contrast extravasation (arrows) was still noted.C. With a second balloon inflation in the stent for another 5 min, the follow-up venogram showed complete exclusion of the pseudoaneurysm.

Mentions: The indications for metallic stent placement in this study included: 1) recoil or kinked residual stenosis of at least 50% (seven patients) or > 30% residual stenosis with early re-occlusion of the graft within a one month interval (14 patients). Seventeen lesions were at the venous anastomosis (eight forearm grafts and nine upper-arm grafts), while four lesions of the forearm grafts were in the downstream outflow veins. The recoil stenosis in one brachial vein was shown to be compressed by the accompanying brachial artery (Fig. 1) on the ultrasound images, and two major vascular leaks after balloon dilations occurred in two upperarm grafts with a large pseudoaneurysm (Fig. 2) and a hematoma formation compromising the outflow vein in one patient each. Wallstent (8-10 mm×40-80 mm, Boston Scientific; Galway, Ireland) was used in our first eight patients, while nitinol stents (8 mm×40-80 mm, Memotherm/Luminexx, Bard, Angiomed, Karlsruhe, Germany) were deployed thereafter in the other 15 patients. Of them, eight stents (including four Wallstents and four nitinol stents) were deployed across the elbow crease while the other 15 stents were deployed in the upper arm region. The stents were usually deployed with overlapping of the graft matrix for 1-1.5 cm for the venous anastomotic lesions. The choice of stent was adapted to the diameter of the blood vessel (usually 1-2 mm larger than that of the adjacent vessel) and according to the stent size that was available at that time in our department.


Metallic stent placement in hemodialysis graft patients after insufficient balloon dilation.

Liang HL, Pan HB, Lin YH, Chen CY, Chung HM, Wu TH, Chou KJ, Lai PH, Yang CF - Korean J Radiol (2006 Apr-Jun)

A 51-year-old female patient with a thrombosed straight graft over her right upper arm.A. A large pseudoaneurysm at the venous anastomosis after PTA was noted, which failed to response to the prolonged balloon inflation.B. After a nitinol Memotherm stent (8×40 mm) was placed and one session of balloon inflation (5 min), small residual contrast extravasation (arrows) was still noted.C. With a second balloon inflation in the stent for another 5 min, the follow-up venogram showed complete exclusion of the pseudoaneurysm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667584&req=5

Figure 2: A 51-year-old female patient with a thrombosed straight graft over her right upper arm.A. A large pseudoaneurysm at the venous anastomosis after PTA was noted, which failed to response to the prolonged balloon inflation.B. After a nitinol Memotherm stent (8×40 mm) was placed and one session of balloon inflation (5 min), small residual contrast extravasation (arrows) was still noted.C. With a second balloon inflation in the stent for another 5 min, the follow-up venogram showed complete exclusion of the pseudoaneurysm.
Mentions: The indications for metallic stent placement in this study included: 1) recoil or kinked residual stenosis of at least 50% (seven patients) or > 30% residual stenosis with early re-occlusion of the graft within a one month interval (14 patients). Seventeen lesions were at the venous anastomosis (eight forearm grafts and nine upper-arm grafts), while four lesions of the forearm grafts were in the downstream outflow veins. The recoil stenosis in one brachial vein was shown to be compressed by the accompanying brachial artery (Fig. 1) on the ultrasound images, and two major vascular leaks after balloon dilations occurred in two upperarm grafts with a large pseudoaneurysm (Fig. 2) and a hematoma formation compromising the outflow vein in one patient each. Wallstent (8-10 mm×40-80 mm, Boston Scientific; Galway, Ireland) was used in our first eight patients, while nitinol stents (8 mm×40-80 mm, Memotherm/Luminexx, Bard, Angiomed, Karlsruhe, Germany) were deployed thereafter in the other 15 patients. Of them, eight stents (including four Wallstents and four nitinol stents) were deployed across the elbow crease while the other 15 stents were deployed in the upper arm region. The stents were usually deployed with overlapping of the graft matrix for 1-1.5 cm for the venous anastomotic lesions. The choice of stent was adapted to the diameter of the blood vessel (usually 1-2 mm larger than that of the adjacent vessel) and according to the stent size that was available at that time in our department.

Bottom Line: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure.For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively.No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

ABSTRACT

Objective: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients.

Materials and methods: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-10 mm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis.

Results: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (+/-standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were 69%+/-9 and 88%+/-6, 41%+/-10 and 88%+/-6, 30%+/-10 and 77%+/-10, and 12%+/-8 and 61%+/-13, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were 51%+/-16 and 86%+/-13 vs 45%+/-15 and 73%+/-13 at 6 months, and 25%+/-15 and 71%+/-17 vs 23%+/-17 and 73%+/-13 at 12 months (p = .346 and .224), respectively.

Conclusion: Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.

Show MeSH
Related in: MedlinePlus