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Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients

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ABSTRACT

Background: Central vein stenosis or occlusion is a common complication that can lead to significant morbidity and dysfunction of access in the hemodialysis patient. More lesions can develop over time, and preserving access becomes a challenge as life expectancy of the hemodialysis patient increases.

Objectives: The goal was to compare long-term results and determine the outcomes of open-cell stent versus closed-cell stent for central vein stenosis or occlusion in hemodialysis patients.

Patients and methods: From 1997 to 2015, in 401 hemodialysis patients, stent placement for central vein stenosis or occlusion was performed if balloon angioplasty was unsatisfactory, due to elastic recoil or occurrence of restenosis within 3 months. When thrombus was present, primary stenting was performed. A total of 257 open-cell stents and 144 closed-cell stents were used. Angiographic findings including lesion site, central vein stenosis or occlusion, and presence of thrombosis and complication were evaluated. Primary patency rate and mean patency rate of the stent were compared between two stent groups by Kaplan-Meier survival analysis.

Results: For the open-cell stent group, 159 patients were diagnosed as central vein stenosis and 98 were occlusion. For the closed-cell stent group, 78 were stenosis and 66 were occlusion. There were two complications for central migration and two for procedure-related vein rupture. Open-cell stents and closed-cell stents had mean patency rates of 10.9 ± 0.80 months and 8.5 ± 10.87 months, respectively (P = 0.002).

Conclusion: The open-cell stent is effective and its performance is higher than that obtained with the closed-cell stent for treating central vein stenosis or occlusion in hemodialysis patients.

No MeSH data available.


Related in: MedlinePlus

Technical failure case; A 46-year-old patient with radio-cephalic fistula. A fluoroscopic image shows collapsed closed-cell stent in the right subclavian vein and follow-up fistulogram shows more than 30% residual stenosis in the subclavian vein (not shown).
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fig38063: Technical failure case; A 46-year-old patient with radio-cephalic fistula. A fluoroscopic image shows collapsed closed-cell stent in the right subclavian vein and follow-up fistulogram shows more than 30% residual stenosis in the subclavian vein (not shown).

Mentions: The technical success rate was 99.3% (398 of 401 procedures). One failure with an open-cell stent involved a successful stent placement, but coexistence of thrombosis in the graft site was not removed completely and the flow was insufficient. Another unsuccessful patient with a closed-cell stent was the result of incorrect stent positioning, thus creating a misplacement of the stent. One failure with the closed-cell stent was the result from stent collapse (Figure 1).


Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients
Technical failure case; A 46-year-old patient with radio-cephalic fistula. A fluoroscopic image shows collapsed closed-cell stent in the right subclavian vein and follow-up fistulogram shows more than 30% residual stenosis in the subclavian vein (not shown).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120236&req=5

fig38063: Technical failure case; A 46-year-old patient with radio-cephalic fistula. A fluoroscopic image shows collapsed closed-cell stent in the right subclavian vein and follow-up fistulogram shows more than 30% residual stenosis in the subclavian vein (not shown).
Mentions: The technical success rate was 99.3% (398 of 401 procedures). One failure with an open-cell stent involved a successful stent placement, but coexistence of thrombosis in the graft site was not removed completely and the flow was insufficient. Another unsuccessful patient with a closed-cell stent was the result of incorrect stent positioning, thus creating a misplacement of the stent. One failure with the closed-cell stent was the result from stent collapse (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Central vein stenosis or occlusion is a common complication that can lead to significant morbidity and dysfunction of access in the hemodialysis patient. More lesions can develop over time, and preserving access becomes a challenge as life expectancy of the hemodialysis patient increases.

Objectives: The goal was to compare long-term results and determine the outcomes of open-cell stent versus closed-cell stent for central vein stenosis or occlusion in hemodialysis patients.

Patients and methods: From 1997 to 2015, in 401 hemodialysis patients, stent placement for central vein stenosis or occlusion was performed if balloon angioplasty was unsatisfactory, due to elastic recoil or occurrence of restenosis within 3 months. When thrombus was present, primary stenting was performed. A total of 257 open-cell stents and 144 closed-cell stents were used. Angiographic findings including lesion site, central vein stenosis or occlusion, and presence of thrombosis and complication were evaluated. Primary patency rate and mean patency rate of the stent were compared between two stent groups by Kaplan-Meier survival analysis.

Results: For the open-cell stent group, 159 patients were diagnosed as central vein stenosis and 98 were occlusion. For the closed-cell stent group, 78 were stenosis and 66 were occlusion. There were two complications for central migration and two for procedure-related vein rupture. Open-cell stents and closed-cell stents had mean patency rates of 10.9 ± 0.80 months and 8.5 ± 10.87 months, respectively (P = 0.002).

Conclusion: The open-cell stent is effective and its performance is higher than that obtained with the closed-cell stent for treating central vein stenosis or occlusion in hemodialysis patients.

No MeSH data available.


Related in: MedlinePlus