HEMODIALYSIS GRAFT SALVAGE WITH ENDOLUMINAL STENTS

The most common cause of failure of hemodialysis access sites is steno sis within the site. The stenoses have traditionally been corrected su rgically, but endovascular techniques may be an alternative method to treat these flow-limiting lesions and maintain graft patency. Over a r ecent 17-month period, endoluminal stents to relieve stenoses resistan t to balloon dilatation alone were placed in 14 access sites. All site s were located on the upper extremity (13 PTFE bridge grafts and 1 A-V fistula). A total of 20 stents were placed: seven at the venous anast omosis, 12 in the venous outflow tract (including 3 in the subclavian vein), and one within the graft. Nine patients had placement of a sing le stent, four patients had two stents placed, and one patient had thr ee. An additional eight stenotic lesions within these 14 sites were su ccessfully dilated without need of a stent. After stent placement, the se 14 sites have remained functional for a mean of 6.2 months. Four we re functioning without further intervention at a mean of 8.5 months. N ine sites occluded at a mean of 4.7 months. The remaining site remaine d functional until death of the patient 10 months after stent placemen t. Of the nine failed sites, four developed restenosis at the site of stent placement, four developed stenoses at other sites, and the other site was abandoned. Three stents were placed in subclavian vein steno ses, and none of these has failed. Further study is necessary to deter mine whether endovascular stenting of dialysis access site stenoses wi ll prove to be a durable, cost-effective alternative to surgical revis ion.