Evaluation of Expanded Polytetrafluoroethylene–covered Stents for the Treatment of Venous Outflow Stenosis in Hemodialysis Access Grafts
| Autor: | Michael D. Kuo, Frank J. Miller, Michael G. Chan, Karim Valji |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Fistula medicine.medical_treatment Constriction Pathologic Kaplan-Meier Estimate Prosthesis Design Constriction Blood Vessel Prosthesis Implantation Arteriovenous Shunt Surgical Coated Materials Biocompatible Renal Dialysis Blood vessel prosthesis Angioplasty Alloys Secondary Prevention medicine Humans Vascular Patency Radiology Nuclear Medicine and imaging Polytetrafluoroethylene Aged Retrospective Studies Venous Thrombosis Heparin business.industry Graft Occlusion Vascular Anticoagulants Retrospective cohort study Middle Aged medicine.disease Thrombosis Blood Vessel Prosthesis Surgery Stenosis Treatment Outcome Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular and Interventional Radiology. 22:647-653 |
| ISSN: | 1051-0443 |
| DOI: | 10.1016/j.jvir.2010.12.013 |
| Popis: | Purpose To investigate the use of an expanded polytetrafluoroethylene–coated nitinol stent-graft in patients with failing hemodialysis access circuits and compare grafts with and without a heparin-coated surface. Materials and Methods A single-institution retrospective review of 16 patients (average age, 55 years; seven men) treated for hemodialysis access circuit stenoses was performed. Patients had a prosthetic arteriovenous (AV) graft ( n = 10) or autogenous AV fistula ( n = 6), all with clinically relevant access stenoses that were refractory to angioplasty alone; 10 patients also had access circuit thrombosis at the time of treatment. Stents were placed in the basilic ( n = 4), brachial ( n = 7), cephalic ( n = 4), and femoral ( n = 1) veins. Study endpoints included primary treatment area patency, primary circuit patency, primary assisted circuit patency, and secondary circuit patency, followed to a maximum of 6 months. Results Primary treatment area patency rates at 30 days and 180 days were 75% and 31%, respectively. Secondary patency rates at the same time points were 88% and 68%, respectively. Mean primary treatment area patency was 93 days. Thrombosis was a major cause of failure, occurring in seven of 11 cases of primary treatment area patency loss. Subgroup analysis demonstrated that the heparin-coated configuration ( n = 7) showed a 6-month primary patency rate of 57%, compared with 11% for the stent-grafts without heparin bonding ( n = 9; P = .06). Conclusions Overall, the majority of deployed stent-grafts lost primary patency within 6 months, with thrombosis a major cause of failure. However, the addition of a heparin-coated surface appeared to improve results in these otherwise treatment-refractory access circuits. |
| Databáze: | OpenAIRE |
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