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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 71-year-old-man with radio-cephalic fistula and left upper arm swelling. A, Fistulogram shows stenosis in left innominate vein. B, Fistulogram obtained after closed-cell stent placement shows incomplete contact of the stent to the vessel wall.
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fig38068: A 71-year-old-man with radio-cephalic fistula and left upper arm swelling. A, Fistulogram shows stenosis in left innominate vein. B, Fistulogram obtained after closed-cell stent placement shows incomplete contact of the stent to the vessel wall.

Mentions: The Wallstent is constructed of Elgiloy, the free ends are sharp and capable of embedding into the vessel wall. Eccentric loading of the Wallstent such as that produced by a stenosis results in concentric narrowing beyond the point at which the load is applied, making it susceptible to reduced wall contact and decreased radial strength (32). Poor or incomplete wall contact appears to be a risk factor for in-stent stenosis (33, 34), and decreased radial strength (29). In this study, there was a case of incomplete wall contact in the closed-cell stent group for stenosis at the left innominate vein (Figure 6). Closed-cell stent has also been observed to migrate and foreshorten in central venous segments (Figure 4) (8, 10, 11, 13). In addition, two cases of central stent migration were observed in patients with closed-cell stent in this study.


Comparison of Open-Cell Stent and Closed-Cell Stent for Treatment of Central Vein Stenosis or Occlusion in Hemodialysis Patients
A 71-year-old-man with radio-cephalic fistula and left upper arm swelling. A, Fistulogram shows stenosis in left innominate vein. B, Fistulogram obtained after closed-cell stent placement shows incomplete contact of the stent to the vessel wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig38068: A 71-year-old-man with radio-cephalic fistula and left upper arm swelling. A, Fistulogram shows stenosis in left innominate vein. B, Fistulogram obtained after closed-cell stent placement shows incomplete contact of the stent to the vessel wall.
Mentions: The Wallstent is constructed of Elgiloy, the free ends are sharp and capable of embedding into the vessel wall. Eccentric loading of the Wallstent such as that produced by a stenosis results in concentric narrowing beyond the point at which the load is applied, making it susceptible to reduced wall contact and decreased radial strength (32). Poor or incomplete wall contact appears to be a risk factor for in-stent stenosis (33, 34), and decreased radial strength (29). In this study, there was a case of incomplete wall contact in the closed-cell stent group for stenosis at the left innominate vein (Figure 6). Closed-cell stent has also been observed to migrate and foreshorten in central venous segments (Figure 4) (8, 10, 11, 13). In addition, two cases of central stent migration were observed in patients with closed-cell stent in this study.

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