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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 74-year-old male patient with a thrombosed straight graft over his left upper arm.A. Recoil (arrow) and kinked (arrowhead) stenosis at the venous anastomosis after PTA was noted.B. A Wallstent (10×80 mm) was deployed across the venous anastomosis with overlapping of the stent with the graft matrix (arrow).C. Stent shortening and migration caused early re-occlusion of the access one month after its placement.D. After simple balloon dilation, the vascular flow was restored, but the access was eventually abandoned another month later.
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Figure 3: A 74-year-old male patient with a thrombosed straight graft over his left upper arm.A. Recoil (arrow) and kinked (arrowhead) stenosis at the venous anastomosis after PTA was noted.B. A Wallstent (10×80 mm) was deployed across the venous anastomosis with overlapping of the stent with the graft matrix (arrow).C. Stent shortening and migration caused early re-occlusion of the access one month after its placement.D. After simple balloon dilation, the vascular flow was restored, but the access was eventually abandoned another month later.

Mentions: One patient with venous anastomotic recoil (an upper arm graft) had dislodgement of the deployed stent, which caused early lost of his access (Fig. 3). No other stent migrations or fractures (including the eight patients with stents across the elbow crease) were encountered during the follow-up period.


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 74-year-old male patient with a thrombosed straight graft over his left upper arm.A. Recoil (arrow) and kinked (arrowhead) stenosis at the venous anastomosis after PTA was noted.B. A Wallstent (10×80 mm) was deployed across the venous anastomosis with overlapping of the stent with the graft matrix (arrow).C. Stent shortening and migration caused early re-occlusion of the access one month after its placement.D. After simple balloon dilation, the vascular flow was restored, but the access was eventually abandoned another month later.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: A 74-year-old male patient with a thrombosed straight graft over his left upper arm.A. Recoil (arrow) and kinked (arrowhead) stenosis at the venous anastomosis after PTA was noted.B. A Wallstent (10×80 mm) was deployed across the venous anastomosis with overlapping of the stent with the graft matrix (arrow).C. Stent shortening and migration caused early re-occlusion of the access one month after its placement.D. After simple balloon dilation, the vascular flow was restored, but the access was eventually abandoned another month later.
Mentions: One patient with venous anastomotic recoil (an upper arm graft) had dislodgement of the deployed stent, which caused early lost of his access (Fig. 3). No other stent migrations or fractures (including the eight patients with stents across the elbow crease) were encountered during the follow-up period.

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