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Metallic Stent Placement for Treating Peripheral Outflow Lesions in Native Arteriovenous Fistula Hemodialysis Patients After Insufficient Balloon Dilatation

¹ Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1^st Rd., Kaohsiung, Taiwan 813, ROC.
² Department of Radiology, National Yang-Ming University, Taipei, Taiwan 813, ROC.
³ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 813, ROC.
⁴ Department of Vascular Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 813, ROC.

OBJECTIVE. The purpose of this study was to report our experience with metallic stent placement in the peripheral outflow veins in native arteriovenous fistula (A-V fistula) hemodialysis patients after insufficient balloon dilatation.

MATERIALS AND METHODS. During the past 4 years, 12 A-V fistula dialysis patients in our hospital underwent metallic stent placement in the peripheral outflow veins to restore vascular access. The indications for metallic stent placement in our study included (1) recoil stenosis of outflow vein in six patients; (2) outflow venous rupture in two patients and dissection in one patient; and (3) large residual adherent thrombus in outflow aneurysms in three patients with thrombosed (arteriovenous) access. Self-expandable Wallstent or Jostent (Jomed, Abbott Laboratories) of appropriate size (6–10 mm in diameter) was chosen for use in these patients. Kaplan-Meier survival analysis was used to calculate the access patency rates.

RESULTS. Twelve patients received stents. Eleven patients (92%) underwent successful dialysis after the procedure. One patient experienced complications due to incorrect positioning of the stent at the anastomotic site, causing flow compromise. The primary patency (± standard error) of the vascular access at 3, 6, 12, and 24 months was 92% ± 8%, 81% ± 12%, 31% ± 17%, and 31% ± 17%, respectively. The secondary patency of the vascular access at 3 months was 92% ± 8%, and 82% ± 12% at 6, 12, and 24 months each.

CONCLUSION. Metallic stent placement is safe and effective in treating peripheral venous lesions in native A-V fistula hemodialysis patients after unsatisfactory balloon dilatation.

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