Metallic Stent Placement in Hemodialysis Graft Patients after Insufficient Balloon Dilation

Objective: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients. Materials and Methods: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients. Metallic stents 8-1 Omm in diameter and 40-80 mm in length were used. Of them, eight stents were deployed across the elbow crease. Access patency was determined by clinical follow-up and the overall rates were calculated by Kaplan-Meier survival analysis. Results: No procedure-related complications (stent fracture or central migration) were encountered except for a delayed Wallstent shortening/migration at the venous anastomosis, which resulted in early access failure. The overall primary and secondary patency rates (${\pm}$ standard error) of all the vascular accesses in our 23 patients at 3, 6, 12 and 24 months were $69%{\pm}9$ and $88%{\pm}6$, $41%{\pm}10$ and $88%{\pm}6$, $30%{\pm}10$ and $77%{\pm}10$, and $12%{\pm}8$ and $61%{\pm}13$, respectively. For the forearm and upper-arm grafts, the primary and secondary patency rates were $51%{\pm}16$ and $86%{\pm}13$ vs $45%{\pm}15$ and $73%{\pm}13$ at 6 months, and $25%{\pm}15$ and $71%{\pm}17$ vs $23%{\pm}17$ and $73%{\pm}13$ at 12 months (p=.346 and .224), respectively. Conclusion: Metallic stent placement is a safe and effective means for treating peripheral venous lesions in dialysis graft patients after insufficient balloon dilation. No statistically difference in the patency rates between the forearm and upper-arm patient groups was seen.