Print this pageDurability of Covered Stents in Maintaining Patency of Upper Extremity Arteriovenous Grafts and Fistulas
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Joshua D. Arnold, MD, L R. Sprouse, MD, C J. Lesar, MD.
UT Chattanooga, Chattanooga, TN, USA.
Objectives
Endovascular therapy has emerged as an alternative to open surgery for revision of arteriovenous grafts and fistulas. Currently the results of traditional percutaneous angioplasty and stent placement have been disappointing for maintaining access patency. However, encouraging results have recently been reported with the use covered stents. The current study was undertaken to evaluate the success of covered stents in maintaining AVF/G at our institution.
Methods
We retrospectively reviewed 45 patients having upper extremity arteriovenous grafts or fistulas who received a covered stent (Bard Fluency 89%, Atrium iCast 6%, Viabahn 6%) for maintenance of fistula patency. The most common indication for placement was venous outflow obstruction (56%). Other indications included in-stent stenosis, thrombus/dissection, inflow stenosis, perforation/bleeding, and pseudoaneurysm. Status of each fistula was ascertained through dialysis records and/or office visit physical exam along with duplex ultrasound. Subsequent interventions were noted along with any adverse events directly related to the covered stent.
Results
All 45 patients had successful placement of a covered stent. There were no complications with sheath insertion and no patient required surgery for postoperative bleeding. The mean primary patency at 6 months was 60% (27/45) with a secondary patency of 78%. Nineteen patients had a follow-up duplex ultrasound at 4 months showing a mean flow volume of 1150 ml/min. Stent failure occurred in 22% resulting operative revision or conversion to a new access. Two stents became infected and required surgical removal and one required operative revision for dermal erosion. No stent fractures or migration have been identified.
Conclusions
Covered stenting appears to provide an effective alternative to traditional PTA and stent placement for maintaining patency of upper extremity fistulas and grafts. Further investigation is warranted to evaluate the long term durability of covered stents in this setting.