Use of Stents for the Maintenance of Hemodialysis Access

Maintenance of patent hemodialysis access is critical to prolonging the lives of patients with end-stage renal disease, and metallic stents have become a key tool for this purpose. This article discusses the primary and secondary indications for stent placement in dialysis patients, including angioplasty-induced acute venous rupture, central venous obstruction, early recurring stenosis, elastic stenosis and pseudoaneurysm. The use of stents in patients with synthetic arteriovenous grafts and native arteriovenous fistulae are discussed. With ongoing advances in stent technology as well as brachytherapy, the role of this device in the maintenance of dialysis access will likely increase. An understanding of the indications, precautions, and complications of stent deployment allows the interventional radiologist to become a principle player in the long-term care of dialysis patients.

KEYWORDS

Stent - graft - fistula - dialysis

REFERENCES

• 1 Hoffer E K, Sultan S, Herskowitz M M et al.. Prospective randomized trial of a metallic intravascular stent in hemodialysis graft maintenance.  J Vasc Interv Radiol. 1997;  8 965-973
• 2 Funaki B, Szymski G X, Leef J A et al.. Treatment of venous outflow stenoses in thigh grafts with Wallstents.  AJR Am J Roentgenol. 1999;  172 1591-1596
• 3 Patel R I, Peck S H, Cooper S G et al.. Patency of Wallstents placed across the venous anastomosis of hemodialysis grafts after percutaneous recanalization.  Radiology. 1998;  209 365-370
• 4 Zaleski G X, Funaki B, Rosenblum J et al.. Metallic stents deployed in synthetic arteriovenous hemodialysis grafts.  AJR Am J Roentgenol. 2001;  176 1515-1519
• 5 Maleux G, Rousseau H, Otal P et al.. Collapsed Palmaz stent after deployment for hemodialysis access-related venous stenosis.  J Vasc Interv Radiol. 1998;  9(1 Pt 1) 169-171
• 6 Asher R M, Huettl E A, Halligan R. Percutaneous retrieval of a Wallstent from the pulmonary artery following stent migration from the iliac vein.  J Interv Cardiol. 2002;  15(2) 101-106
• 7 Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther R W. Treatment of hemodialysis-related central venous stenosis or occlusion; results of primary Wallstent placement and follow-up in 50 patients.  Radiology. 1999;  212 175-180
• 8 Rajan D K, Clark T W. Patency of Wallstents placed at the venous anastomosis of dialysis grafts for salvage of angioplasty-induced rupture.  Cardiovasc Intervent Radiol. 2003;  26 242-245
• 9 Funaki B, Szymski G X, Leef J A, Rosenblum J D, Burke R, Hackworth C A. Wallstent deployment to salvage dialysis graft thrombolysis complicated by venous rupture: early and intermediate results.  AJR Am J Roentgenol. 1997;  169 1435-1437
• 10 Rajan D K, Clark T W, Patel N K et al.. Prevalence and treatment of cephalic arch stenosis in dysfunctional autologous hemodialysis fistulas.  J Vasc Interv Radiol. 2003;  14(5) 567-573
• 11 Delorme J M, Guidoin R, Canizales S et al.. Vascular access for hemodialysis: pathologic features of surgically excised PTFE grafts.  Ann Vasc Surg. 1992;  6 517-524
• 12 Ryan J M, Siobhan D A, Doherty J et al.. Using a covered stent (Wallgraft) to treat pseudoaneurysms of dialysis grafts and fistulas.  AJR Am J Roentgenol. 2003;  180 1067-1071
• 13 Rabindranauth P, Shindelman L. Transluminal stent-graft repair for pseudoaneurysm of PTFE hemodialysis grafts.  J Endovasc Surg. 1998;  5(2) 138-141
• 14 Najibi S, Bush R L, Terramani T T et al.. Covered stent exclusion of dialysis access pseudoaneurysms.  J Surg Res. 2002;  106(1) 15-19
• 15 El-Sabrout R A, Duncan J M. Right atrial bypass grafting for central venous obstruction associated with dialysis access: another treatment option.  J Vasc Surg. 1999;  30(3) 582-584
• 16 Lumsden A B, MacDonald M J, Isiklar H et al.. Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment.  Cardiovasc Surg. 1997;  5(5) 504-509
• 17 Vesely T M, Hovespian D M, Pilgram T K et al.. Upper extremity central venous obstruction in hemodialysis patients: treatment with Wallstents.  Radiology. 1997;  204(2) 343-348
• 18 Verstandig A G, Bloom A I, Sasson T et al.. Shortening and migration of Wallstents after stenting of central venous stenoses in hemodialysis patients.  Cardiovasc Intervent Radiol. 2003;  26(1) 58-64
• 19 Chen C Y, Liang H L, Pan H B et al.. Metallic stenting for treatment of central venous obstruction in hemodialysis patients.  J Chin Med Assoc. 2003;  66(3) 166-172
• 20 McIntyre C W, Taal M W, Fluck R J et al.. Adherence of tunneled haemodialysis catheter to superior vena caval stent: successful percutaneous removal.  Nephrol Dial Transplant. 2003;  18 432-433
• 21 Prahlow J A, O'Bryant T J, Barnard J J. Cardiac perforation due to Wallstent embolization: a fatal complication of the transjugular intrahepatic portosystemic shunt procedure.  Radiology. 1997;  205(1) 170-172
• 22 Bartorelli A L, Fabbiocchi F, Montorsi P et al.. Successful transcatheter management of Palmaz stent embolization after superior vena cava stenting.  Cathet Cardiovasc Diagn. 1995;  34(2) 162-166
• 23 Slonim S M, Dake M D, Razavi M K et al.. Management of misplaced or migrated endovascular stents.  J Vasc Interv Radiol. 1999;  10(7) 851-859
• 24 Evans J, Saba Z, Rosenfeld H et al.. Aortic laceration secondary to Palmaz stent placement for treatment of superior vena cava syndrome.  Catheter Cardiovasc Interv. 2000;  49(2) 160-162
• 25 Martin M, Baumgartner I, Kolb M et al.. Fatal pericardial tamponade after Wallstent implantation for malignant superior vena cava syndrome.  J Endovasc Ther. 2002;  9(5) 680-684
• 26 Farber A, Barbey M M, Grunert J H et al.. Access-related venous stenoses and occlusions: treatment with percutaneous transluminal angioplasty and Dacron-covered stents.  Cardiovasc Intervent Radiol. 1999;  22(3) 214-218
• 27 Morice M C, Serruys P W, Sousa J E et al.. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization.  N Engl J Med. 2002;  346 1773-1780
• 28 Kwok P C, Wong K M, Ngan R K et al.. Prevention of recurrent central venous stenosis using endovascular irradiation following stent placement in hemodialysis patients.  Cardiovasc Intervent Radiol. 2001;  24(6) 400-406
• 29 Su S H, Chao R Y, Landau C L et al.. Expandable bioresorbable endovascular stent.  Fabrication and properties. Ann Biomed Eng. 2003;  31(6) 667-677
• 30 Fattori R, Piva T. Drug-eluting stents in vascular intervention.  Lancet. 2003;  361(9353) 247-249
• 31 Guest S S, Kirsch C M, Baxter R et al.. Infection of a subclavian venous stent in a hemodialysis patient.  Am J Kidney Dis. 1995;  26(2) 377-380