Non-apposed stent graft size placement reduces edge stenosis in the peripheral outflow vein of hemodialysis patients.

Abstract

Purpose: To evaluate the risk of edge stenosis in the peripheral outflow vein(OFV)ofhemodialysis patients in association with apposed versus non-apposed stent-graftplacement.

Materials and methods: The indications of stent-graft placement in this study were early- recoil vascular stenosis or vascular peroration after balloon dilation in either arterio- venous graft (AVG) or fistula (AVF) patients. Only the stent-end located within the peripheral OFV was included. The non-apposed patients were further divided into 3groups ashaving received undersized, in-valve and in-aneurysm placement.Endoprostheses 5-8 mm in diameter (Viabahn, or Covera) was utilized. Target lesionprimary patency (TLPP), access circuit primary patency (ACPP) and secondary access patency were analyzed and reported.

Results: 138 patients (47 male and 91 female) with a total of 145 stent-graft endsdeployed in the peripheral OFV (AVG: 79, AVF: 66) were retrospectively reviewed. 54stent-grafts were classified as apposed, and 91 as non-apposed (undersized: 51, in-valve: 25, and in-aneurysm:15). Technical and clinical successes were achieved in 100%. The median ACPP of the apposed and non-apposed patients were 3 and 6 months (p=0.001). The median TLPP of the apposed and non-apposed groups were 6 and 26 months (p < 0.001) with 16 months in the undersized subgroup, 24 months in the in-valve subgroup, and not-reached in the in-aneurysm subgroup (p=0.003).

Conclusion: In hemodialysis patients, non-apposed stent placements showed a better TLPP rates, especially in the in-valve and in-aneurysm patient subgroups, which is contrary to the manufacturer's instructions for use and the results of some prior published articles.