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Review
. 2022 Feb 18;39(1):75-81.
doi: 10.1055/s-0042-1742390. eCollection 2022 Feb.

Stent Graft Outcomes in Dialysis Circuits: A Review of Clinical Trials and Literature

Austin J Pourmoussa  1 , Ashwin M Mahendra  1 , Constantino S Peña  1   2 , Alex Powell  1 , Brian J Schiro  1 , Raul Herrera  1   3 , Barry T Katzen  1   2 , Govindarajan Narayanan  1   2 , Andrew S Niekamp  1 , Ripal T Gandhi  1   2
Affiliations
Review

Stent Graft Outcomes in Dialysis Circuits: A Review of Clinical Trials and Literature

Austin J Pourmoussa et al. Semin Intervent Radiol. .

Abstract

End-stage renal disease is a prevalent medical condition causing significant problems as the majority of patients are being treated with dialysis. While dialysis provides a means to compensate for the renal impairment, arteriovenous grafts and fistulas are often complicated by neointimal hyperplasia, loss of primary patency, and graft failure. Over the last decade, stent grafts have emerged as an alternative to balloon angioplasty and bare metal stents for revascularization in the event of arteriovenous graft occlusion or stenosis. Several randomized controlled trials have investigated the efficacy of stent grafts compared with balloon angioplasty for improving the function and durability of dialysis circuits. In this review, we present a comprehensive review of clinical trials. Stent grafts appear to offer increased primary patency over balloon angioplasty in the treatment of dialysis circuit stenosis. However, there is generally no significant difference between the two treatment modalities on other clinically relevant measures like complication rates and overall survival.

Keywords: bare metal stent; dialysis circuit; interventional radiology; patency; percutaneous transluminal angioplasty; stent graft.

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Conflict of interest statement

Conflicts of Interest C.S.P. is a consultant for Cordis, Avanos, Philips Medical; is on the advisory boards for Boston Scientific, Venture Med, and Surmodics; is a speaker for Abott Medical, Bard, Sirtex, Terumo, Penumbra, Shockwave, and Cook Medical; is an investor in Cagent Medical and Integrity Spine; and CEC: Micromedex and Intact Vascular. B.J.S. is a consultant and speaker for Medtronic, Penumbra, and Philips. R.T.G. is a consultant for Medtronic, Bard, and Cordis.

Figures

Fig. 1
Fig. 1
Angiography demonstrating a thrombosed AV graft. Arrow—graft. Arrowhead—dominant outflow vein.
Fig. 2
Fig. 2
Following declotting of the AV graft, there was a greater than 50% stenosis within the venous outflow. ( a ) Positioning of a 7 mm × 100 mm Viabahn stent within AV graft (arrow). ( b ) Ballooning of covered stent (arrow).
Fig. 3
Fig. 3
( a ) Filling defect at arterial anastomosis most likely representing thrombus (arrow). ( b ) Attempted balloon angioplasty and removal of thrombus.
Fig. 4
Fig. 4
Residual stenosis at the arterial anastomosis, which was successfully treated with an additional Viabahn stent graft. Subsequent graftogram shows an excellent angiographic result.
Fig. 5
Fig. 5
( a ) Color Doppler image of patent arterial anastomosis at 5-month follow-up. ( b ) Color Doppler image of patent venous anastomosis at 5-month follow-up.
See this image and copyright information in PMC

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