WALLSTENTS AND CRAGGSTENTS IN HEMODIALYSIS GRAFTS AND FISTULAS - RESULTS FOR SELECTIVE INDICATIONS

PURPOSE: To report the value of selective placement of self-expandable stents (Wallstent and Craggstent) for the treatment of limitations an d, occasionally, of complications of dilation in hemodialysis access, and especially for delaying restenosis. MATERIALS AND METHODS: This is a retrospective study of a 7-year period, during which 41 Wallstents and 11 Craggstents were placed in 26 polytetrafluoroethylene (PTFE) gr afts, 15 native fistulas, and nine central veins of 47 patients, The i ndications were stenosis recoil (n = 13), recurrent restenosis within 6 months (n = 33), restenosis after 6 months (n = 3), and acute angiop lasty-induced rupture (n = 1). Restenosis after stent placement necess itated redilation and percutaneous declotting and 10 additional stent placements. RESULTS: Two initial misplacements were corrected immediat ely Primary patency rates for PTFE grafts were 58% +/- 10% at 6 months and 23% +/- 10% at 1 year, respectively, Secondary patency rates were 100% at 6 months and 88% +/- 8% at 1 year, respectively, For native f istulas, primary patency rates were 47% +/- 12% at 6 months and 20% +/ - 18% at 1 year, Secondary patency rates were 95% +/- 6% at 6 months a nd 79% +/- 14% at 1 year, It was necessary to reintervene after stent placement to maintain or to restore patency every 9 months for PTFE gr afts and every 7.3 months for native fistulas, When stents were placed for treatment of early recurring restenosis, the mean interval betwee n radiologic interventions (redilations or declottings) performed to m aintain or to restore patency before stent placement was multiplied by 2.1 after stent placement for both grafts (3.2 months increased to 6. 9, P < .01) and native fistulas (2.9 months increased to 6.2, P < .02) . CONCLUSIONS: Wallstents and Craggstents are valuable for the treatme nt of failure of regular dilation and they double the intervals betwee n reinterventions for early (< 6 months) recurring stenoses in PTFE gr afts and native fistulas.