Use of Covered Stents in Cannulation Sites as a Last Option to Salvage Failing Vascular Access

Abstract

Purpose: Controversy exists regarding the treatment of recurrent stenosis in vascular access at cannulation sites with a covered stent as repeated cannulation may damage the stent. The purpose of this study was to review covered stent placement at cannulation sites to salvage failing vascular access.

Materials and methods: A total of 11 patients were included for the purpose of this study. Eight patients (72.7%) received a covered stent due to recurrent stenosis, 2 (18.2%) due to an acute occlusion, and in 1 case (9.1%), the covered stent was used to repair a damaged polytetrafluoroethylene arteriovenous graft (PTFE AVG).

Results: Primary patency after stent placement was 40.9% at 6 months, primary-assisted patency was 79.5% at 12 months, and secondary patency was 80% at 24 months. No significant problems were observed during the dialysis sessions after stent placement. The intervention rate per patient-year was not significantly different before or after covered stent placement, at 3.8 (IQR=9.5) interventions per year versus 2.5 (IQR=3.0) interventions per year (p=0.280).

Conclusion: In conclusion, treating failing vascular access with problems at cannulation sites with covered stents can be considered.

Clinical impact: Treating vascular access stenosis at cannulation sites with covered stents can successfully prolong vascular access life.

Keywords: covered stent graft; endovascular treatment/therapy; hemodialysis; puncture; vascular access.

Figure 1.

Kaplan–Meier survival curve. Dashed lines represent a value with a standard error of more than 10%.

Figure 2.

X-ray of covered stents in different patients. (A) After 6 months of cannulation. (B) After approximately 12 months of cannulation. (C) After 18 months of cannulation. (D) An angiographic example of a covered stent after approximately 2 years of cannulation.