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. 2020 Feb 10;14(3):814-819.
doi: 10.1093/ckj/sfz193. eCollection 2021 Mar.

Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi

José García-Medina  1 , Ana B Maldonado-Cárceles  2   3 , Juan J García-Alfonso  2 , Julián J Árense-Gonzalo  2 , Alberto M Torres-Cantero  2   4
Affiliations

Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi

José García-Medina et al. Clin Kidney J. .

Abstract

Background: Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this study was to analyse patency rates of post-interventional covered stent deployment in those cases. We also assessed if patency rates differed when fistulas were punctured through the stent during dialysis sessions.

Methods: We conducted a retrospective study between 2006 and 2014 analysing post-intervention primary patency rates using the Kaplan-Meier log-rank test. Multivariate Cox proportional regression models were performed to determine if cannulation within the stent graft area was a potential risk factor for occlusion, by adjusted hazard ratio (HR).

Results: A total of 27 procedures were included in the study. Primary patency rates (%) after stent deployment at 3, 6, 12, 24, 36 and 72 months were, respectively: total 59, 32, 32, 21, 11 and 5; stent puncture 53, 21, 21, 16, 5 and 0; and no stent puncture 80, 80, 80, 40, 40 and 40. Cannulation through the stent graft was not significantly associated with increased risk of obstruction in multivariate analysis (HR = 3.01; P = 0.286).

Conclusion: Stent graft treatment may be a feasible procedure in partially thrombosed aneurysms and residual thrombi in AVF. Although fistulas punctured through the stent presented lower patency rates, this practice was not associated with a higher risk of obstruction. Giving the impossibility of comparing with similar approaches, further studies are needed to confirm or refute the advantages of this procedure.

Keywords: aneurysm; arteriovenous fistula; renal dialysis; stents; thrombosis; vascular patency.

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Figures

FIGURE 1
FIGURE 1
Manual thromboaspiration in an ulnar AVF. (A) Catheter (white arrow) and security wire (black arrow). (B) An anastomotic stenosis was dilated. (C) Residual parietal thrombus in basilic vein (white arrow). (D) Stent graft (Fluency, Bard) was implanted (white arrow).
FIGURE 2
FIGURE 2
Multivariate Cox regression models evaluating patency rates of post-interventional covered stent deployment in wall-adherent thrombus aneurysm or residual wall-adherent thrombus in AVF for haemodialysis. Post-interventional primary patency rates for total cohort (A) and according to stent puncture (B) (P ≥ 0.05).
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