Covered stents at cannulation sites in recurrent stenosis in vascular access

Vascular access life can be extended by treating vascular access stenosis with covered stents at cannulation sites according to review results published in the Journal of Endovascular Therapy.

Researchers evaluated the results of placement of a covered stent over cannulation sites to salvage failed vascular access. They conducted a retrospective study that included 11 of 856 patients from a prospectively maintained database in a single-center cohort study with chronic renal dysfunction requiring hemodialysis. The patients were treated between November 2004 and December 2021.

Of the 11 patients who received covered stent placement over cannulation sites to salvage failed vascular access between 2018 and 2021 (median age at stent placement: 63.0 years; 7 females), there were 4 procedures in patients with brachiocephalic arteriovenous fistulas, 5 in patients with arteriovenous graft, and 2 in patients with basilic vein transposition. There were 8 patients who received a covered stent due to recurrent stenosis, 2 due to acute occlusion, and in 1 case repair of a damaged polytetrafluoroethylene arteriovenous graft was performed with a stent covered.


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Researchers found that at 6 months primary patency after stent placement was 40.9%, at 12 months primary assisted patency was 79.5% and at 24 months secondary patency was 80 %. They noted that the intervention rate per patient-year was not statistically different before (3.8 [IQR=9.5] interventions per year) or after (2.5 [IQR=3.0] interventions per year; P =.280) covered stent placement. They reported no significant problems observed during dialysis sessions after stent placement.

Limitations of the review include insufficient sample size and retrospective study design.

“Based on our findings, treatment of vascular access stenosis at cannulation sites with covered stents should be considered to prolong vascular access life with similar intervention rates and acceptable patency rates in these frail patients on hemodialysis,” the study authors wrote.

Reference

Drouven JW, Bruin C, van Roon AM, et al. Use of covered stents in cannulation sites as a last option to save failed vascular access. J Endovasc Ther. Published online August 16, 2022. doi:10.1177/15266028221116745