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Lee HN, Park SJ, Cho Y, Lee S. SUPERA stent placement for salvaging early recurrent arteriovenous graft thrombosis after percutaneous transluminal angioplasty: A single-center study. J Vasc Access 2024; 25:1285-1292. [PMID: 36932956 DOI: 10.1177/11297298231160196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the patency of the helical interwoven SUPERA stent for salvaging prosthetic arteriovenous (AV) grafts with rapidly recurrent thrombotic occlusion developed within a short time period after successful percutaneous transluminal angioplasty. METHODS From December 2019 to September 2021, the data of 20 patients with AV graft who had the SUPERA stent inserted satisfying the following conditions were consecutively collected. (1) More than 1 year has passed since the AV access operation; (2) Thrombotic re-occlusion of AV graft occurred within 3 months after previous successful endovascular treatment; (3) Residual stenosis is greater than 30% after full effacement of balloon angioplasty in the primary lesion. Post-interventional target lesion primary patency (TLPP), access circuit primary patency (ACPP), and secondary patency (SP) were calculated. RESULTS Primary lesions of early recurrent arteriovenous graft thrombosis were found in 13 patients with graft-vein anastomosis, six patients with intra-graft stenosis, and one patient with outflow vein complications. The lesions showed residual stenosis in 47.4% (interquartile range: 44.1%-55.3%) of patients despite full-effacement balloon angioplasty. Clinical success was achieved in all patients with full-expansion of the stents at the 1-month follow-up. The TLPP was 70.7% and 32% at 6 and 12 months, respectively, and ACPP was 47.5% and 6.8% at 6 and 12 months, respectively. The SP was 76.1% and 57.1% at 6 and 12 months, respectively. No cannulation complications occurred in the six patients with installation inside the graft. No hemodialysis or stent fracture occurred in any patient during the follow-up period. CONCLUSIONS The SUPERA stent may have a role in salvaging AV grafts with early recurrent thrombosis due to its greater radial force and its conformability and can be useful in treating stenosis involving the elbow or axilla, with fair patency and low complication rates.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, South Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Gangwon-do, South Korea
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju-si, South Korea
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2
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Aronhime S, Timokhin A, Balan S, Avital Y, Cherniavsky A. Patency and Durability of Stent Grafts Placed in the Dialysis Circuit Cannulation Zone. J Vasc Interv Radiol 2024; 35:86-91. [PMID: 37748575 DOI: 10.1016/j.jvir.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE To investigate the safety, durability, and patency rates of stent grafts (SGs) placed in the cannulation zone of hemodialysis access circuits. MATERIALS AND METHODS From April 2020 to April 2023, all procedures with SGs placed in the cannulation zone were retrospectively analyzed. A total of 40 patients (25 men and 15 women) with SGs placed in the cannulation zone were included in the study. Mean age of the patients was 70 years. The Covera covered stent (BD, Franklin Lakes, New Jersey) was used in all cases. Of these, 26 were arteriovenous (AV) fistulae and 14 were AV grafts. SGs were placed for residual stenosis, perforation, aneurysm, and thrombosis. Follow-up outcomes were determined using follow-up angiographic images and included primary patency, primary-assisted patency, and secondary patency. RESULTS The primary patency of the target lesion was 89% (SD ± 5) and 74% (SD ± 8.4) at 6 and 12 months, respectively. The primary-assisted patency was 89% (SD ± 5.2) and 78% (SD ± 7.6) at 6 and 12 months, respectively. Secondary patency of the access circuit was 97% (SD ± 2.5) at both 6 and 12 months. Mean follow-up was 332 days (range, 28-661 days). All SGs were successfully cannulated for hemodialysis. No cases of stent fracture or stent infection were observed during follow-up. CONCLUSIONS SGs placed for cannulation zone pathologies can be safely cannulated for dialysis and have adequate short- and mid-term patency rates.
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Affiliation(s)
- Shimon Aronhime
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Israel, Tel Aviv University, Tel Aviv, Israel.
| | - Alexey Timokhin
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Israel, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Balan
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Israel, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Avital
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Israel, Tel Aviv University, Tel Aviv, Israel
| | - Alexei Cherniavsky
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Israel, Tel Aviv University, Tel Aviv, Israel
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3
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Haskal ZJ, Dolmatch BL. Hemodialysis Access Stent Graft Trials: Past, Present, and Future. Cardiovasc Intervent Radiol 2023; 46:1154-1161. [PMID: 36941431 DOI: 10.1007/s00270-023-03389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Ziv J Haskal
- School of Medicine, University of Virginia, Charlottesville, USA.
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4
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Shaikh A, Albalas A, Desiraju B, Dwyer A, Haddad N, Almehmi A. The role of stents in hemodialysis vascular access. J Vasc Access 2023; 24:107-116. [PMID: 33993804 PMCID: PMC10896277 DOI: 10.1177/11297298211015069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Vascular access is the Achilles' heel of dialysis therapy among patient with end stage kidney disease. The development of neointimal hyperplasia and subsequent stenosis is common in vascular access and is associated with significant morbidity. Percutaneous transluminal angioplasty using balloon inflation was the standard therapy of these lesions. However, the balloon-based approaches were associated with poor vascular access patency rate necessitating new inventions. It is within this context that different types of stents were developed in order to improve the overall dialysis vascular access functionality. In this article, we review the available literature regarding the use of stents in treating dialysis vascular access stenotic lesions. Further, we review the major clinical trials of stent use in different anatomic locations and in different clinical scenarios.
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Affiliation(s)
- Aisha Shaikh
- Department of Medicine, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Alian Albalas
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brinda Desiraju
- Department of Medicine, SUNY Downstate School of Medicine, Brooklyn, NY, USA
| | - Amy Dwyer
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Nabil Haddad
- Department of Medicine, The Ohio State University Medical Center, Columbus, OH, USA
| | - Ammar Almehmi
- Department of Medicine and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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5
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Beathard GA, Jennings WC, Wasse H, Shenoy S, Falk A, Urbanes A, Ross J, Nassar G, Hentschel DM, Sachdeva B, Chan MR, Salman L, Asif A. ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology. J Vasc Access 2021; 24:358-369. [PMID: 34392712 DOI: 10.1177/11297298211033519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities. However, the correlation between percentage stenosis and a clinically significant decrease in access blood flow (Qa) is low. The critical parameter is the absolute minimal luminal diameter (MLD) of the lesion. This is the parameter that exerts the key restrictive effect on Qa and results in hemodynamic and functional implications for the access. CAS is the result of low wall shear stress (WSS) resulting from the effects of increased blood flow and the unique anatomical configuration of the CAS. Decrease in WSS has a linear relationship to increased blood flow velocity and neointimal hyperplasia exhibits an inverse relationship with WSS. The result is a stenotic lesion. The presence of downstream venous stenosis causes an inflow-outflow mismatch resulting in increased pressure within the access. Qa in this situation may be decreased, increased, or within a normal range. Over time, the increased intraluminal pressure can result in marked aneurysmal changes within the AVF, difficulties with cannulation and the dialysis treatment, and ultimately, increasing risk of access thrombosis. Complete characterization of the lesion both hemodynamically and anatomically should be the first step in developing a strategy for management. This requires both access flow measurement and angiographic imaging. Patients with CAS present a relatively broad spectrum as relates to both of these parameters. These data should be used to determine whether primary treatment of CAS should be directed toward the anatomical lesion (small MLD and low Qa) or the pathophysiology (large MLD and high Qa).
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Affiliation(s)
| | - William C Jennings
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Surendra Shenoy
- Washington University and Barnes-Jewish Hospital, Saint Louis, MO, USA
| | | | - Aris Urbanes
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - John Ross
- Regional Medical Center of Orangeburg and Calhoun Counties, Dialysis Access Institute, Orangeburg, SC, USA
| | - George Nassar
- Weill Cornell Medicine and Houston Methodist Hospital, Houston, TX, USA
| | | | - Bharat Sachdeva
- LSU Health Shreveport School of Medicine, Shreveport, LA, USA
| | - Micah R Chan
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | | | - Arif Asif
- Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Neptune, NJ, USA
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Jaffer O, Gibbs P, Gibson M, Gilbert J, Hanko J, Jeevaratnam P, Jones R, Nicholas J, Ramnarine R, Sivaprakasam R, Steiner K, Tippett R, Wilkins J. A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1736-1746. [PMID: 34231014 DOI: 10.1007/s00270-021-02875-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Stenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus. METHODS A modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice. RESULTS The usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultra-high-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions. CONCLUSIONS These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.
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Affiliation(s)
- Ounali Jaffer
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK.
| | - Paul Gibbs
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Matthew Gibson
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - James Gilbert
- Oxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jennifer Hanko
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Robert Jones
- University Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Johann Nicholas
- Royal Shrewsbury Hospital, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Raymond Ramnarine
- Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Rajesh Sivaprakasam
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK
| | - Kate Steiner
- Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Richard Tippett
- Dorset County Hospital, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Jason Wilkins
- King's College Hospital NHS Foundation Trust, London, UK
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Lin MS, Drucker C, Tolaymat B, Jinwala F, Nagarsheth K. Salvage of autogenous dialysis access with balloon-assisted thrombin injection. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:686-689. [PMID: 33294754 PMCID: PMC7691536 DOI: 10.1016/j.jvscit.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022]
Abstract
Arteriovenous fistulas are known to be one of the most enduring and safe hemodialysis access modalities. However, access preservation can be challenging in the setting of degeneration, including the development of complex pseudoaneurysms. Prolonged compression or thrombin injection can risk thrombosis of the fistula, and covered stent use can predispose the access to infection and other stent complications. We present a case in which endovascular balloon occlusion was used to facilitate the use of ultrasound-guided thrombin injection to resolve a dialysis access pseudoaneurysm by transiently reducing flow and preventing thromboembolism. This method is a safe, effective, and minimally invasive technique that should be considered for salvage of autogenous access compromised by pseudoaneurysm development.
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Affiliation(s)
- Mary S Lin
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Charles Drucker
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Besher Tolaymat
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Felecia Jinwala
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
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8
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Rockley M, Nagpal S, Gupta A, Roberts DJ. Efficacy and safety of secondary procedures for maintaining arteriovenous hemodialysis access patency: protocol for a systematic review and network meta-analysis. Syst Rev 2020; 9:193. [PMID: 32825841 PMCID: PMC7442986 DOI: 10.1186/s13643-020-01435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arteriovenous (AV) hemodialysis access creation is recommended by international guidelines as the preferred method of hemodialysis access. However, most AV access sites will require revision to maintain patency. Although several treatment options exist, many have not been directly compared. We intend to compare the relative effectiveness of methods to maintain post-intervention primary patency of failing AV access. METHODS We will search EMBASE, MEDLINE, CENTRAL, trial registries, the grey literature, and ancestry and citation search from January 1977 to present, for randomized controlled trials comparing interventions to maintain primary patency of AV access. Two investigators will independently and blindly review all identified citations and extract data from included studies. The primary outcome is the primary patency 6 months after intervention. Secondary outcomes include immediate technical and functional success, reinterventions, patency, and mortality. Risk of bias, subgroup analyses, and sensitivity analyses are planned. DISCUSSION There are a number of treatment modalities for the management of failing AV access. However, most modalities have only been directly compared with plain old balloon angioplasty, and currently synthesized evidence focuses on individual pairwise comparisons. In light of the lack of comprehensively synthesized evidence and clinical equipoise, our study intends to synthesize currently available evidence though it is unclear which treatment modality is most effective. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020148224.
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Affiliation(s)
- Mark Rockley
- University of Ottawa, Ottawa, ON, K1N6N5, Canada.,Division of Vascular and Endovascular Surgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, K1Y4E9, Canada
| | - Sudhir Nagpal
- University of Ottawa, Ottawa, ON, K1N6N5, Canada.,Division of Vascular and Endovascular Surgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, K1Y4E9, Canada
| | - Ashish Gupta
- University of Ottawa, Ottawa, ON, K1N6N5, Canada.,Division of Angiography and Interventional Radiology, Department of Radiology, The Ottawa Hospital - Civic Campus, Ottawa, ON, K1Y4E9, Canada
| | - Derek J Roberts
- University of Ottawa, Ottawa, ON, K1N6N5, Canada. .,Division of Vascular and Endovascular Surgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, K1Y4E9, Canada.
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9
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Kitrou PM, Katsanos K, Papadimatos P, Theofanis M, Christeas N, Lampropoulos G, Karnabatidis D. Use of the Covera Stent Graft for the Treatment of Dysfunctional or Thrombosed Arteriovenous Grafts: A Retrospective Analysis of 64 Patients. J Vasc Interv Radiol 2020; 31:630-634. [PMID: 32127320 DOI: 10.1016/j.jvir.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of the Covera stent graft (SG) for the treatment of dysfunctional or thrombosed arteriovenous grafts (AVGs). MATERIALS AND METHODS Within 29 months (February 2016-August 2018), 79 patients underwent Covera SG placement in the authors' department for the treatment of dysfunctional AVGs. Data were available for 64 patients who underwent 64 procedures, using 64 devices. Minimum follow-up was 6 months, unless reintervention occurred. Mean follow-up was 277 days (6-923 days). Treatment characteristics were 51 cases with venous-graft anastomosis (VGA) stenosis (79.7%), 13 cases of puncture zone stenosis (20.3%), 14 cases of in SG stenosis (21.9%), 8 cases of pseudoaneurysm treatment (12.5%) (1 treatment area might have had more than 1 characteristic). Thirty-six patients presented with thrombosis (56.2%), and 31 of 64 case were de novo treatment areas (48.4%). Primary outcome measurements were technical success and post-intervention primary patency (PIPP) at 6 months, whereas secondary outcome measurements included factors influencing primary outcome. RESULTS Technical success was 100%. Median PIPP was 336 days, and 73.6% of treatment areas were patent at 6 months. There were no significant differences in terms of PIPP when de novo treatment areas were compared with restenotic areas (519 vs. 320 days, respectively; P = .1); patients who presented with versus those who presented without thrombosis (320 vs. 583 days, respectively; P = .07); puncture zone stenosis or elsewhere (329 vs. 686 days, respectively; P = .52); and VGA stenosis or elsewhere (336 vs. 335 days, respectively; P = .9). CONCLUSIONS Use of the Covera SG for AVG treatment was safe and effective in every type of treatment area presented in this retrospective analysis.
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Affiliation(s)
- Panagiotis M Kitrou
- Interventional Radiology Department, Patras University Hospital, Patras 26500, Greece.
| | - Konstantinos Katsanos
- Interventional Radiology Department, Patras University Hospital, Patras 26500, Greece
| | | | - Michail Theofanis
- Interventional Radiology Department, Patras University Hospital, Patras 26500, Greece
| | - Nicolaos Christeas
- Interventional Radiology Department, Patras University Hospital, Patras 26500, Greece
| | - George Lampropoulos
- Vascular Surgery Department, Patras University Hospital, Patras 26500, Greece
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