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

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

A 46-year-old patient with brachio-basilic fistula. A, Fistulogram shows segmental stenosis with severe tortuosity and pronounced collateral flow at left innominate vein. B, Fistulogram shows restoration of flow and vanishing of collateral vessels after open-cell stent placement.
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fig38067: A 46-year-old patient with brachio-basilic fistula. A, Fistulogram shows segmental stenosis with severe tortuosity and pronounced collateral flow at left innominate vein. B, Fistulogram shows restoration of flow and vanishing of collateral vessels after open-cell stent placement.

Mentions: The efficacy of stent deployment appears to vary by the vascular location of the stenotic lesion. Recently, nitinol stents have been introduced and have several physical characteristics that may confer longer patency compared with Wallstents (28). Nitinol, an alloy of nickel and titanium, exists in two temperature-dependent forms, which are predetermined by adjusting the ratio of nickel and titanium and through high-temperature heating. When nitinol assumes its higher-temperature form, it expands to its predetermined size and becomes more rigid. Nitinol is also superelastic in that it will deform its shape but return to its original configuration when an external force is applied and then removed (29-31). Shape memory and superelasticity allow for an improved apposition of the stent along the vessel wall and maintenance of radial strength (Figure 5).


Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients
A 46-year-old patient with brachio-basilic fistula. A, Fistulogram shows segmental stenosis with severe tortuosity and pronounced collateral flow at left innominate vein. B, Fistulogram shows restoration of flow and vanishing of collateral vessels after open-cell stent placement.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig38067: A 46-year-old patient with brachio-basilic fistula. A, Fistulogram shows segmental stenosis with severe tortuosity and pronounced collateral flow at left innominate vein. B, Fistulogram shows restoration of flow and vanishing of collateral vessels after open-cell stent placement.
Mentions: The efficacy of stent deployment appears to vary by the vascular location of the stenotic lesion. Recently, nitinol stents have been introduced and have several physical characteristics that may confer longer patency compared with Wallstents (28). Nitinol, an alloy of nickel and titanium, exists in two temperature-dependent forms, which are predetermined by adjusting the ratio of nickel and titanium and through high-temperature heating. When nitinol assumes its higher-temperature form, it expands to its predetermined size and becomes more rigid. Nitinol is also superelastic in that it will deform its shape but return to its original configuration when an external force is applied and then removed (29-31). Shape memory and superelasticity allow for an improved apposition of the stent along the vessel wall and maintenance of radial strength (Figure 5).

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