Em. Masuda et al., STENT-GRAFT ARTERIOVENOUS-FISTULA - AN ENDOVASCULAR TECHNIQUE IN HEMODIALYSIS ACCESS, Journal of endovascular surgery, 5(1), 1998, pp. 18-23
Purpose: To determine the feasibility and safety of a new endovascular
technique for creating an arteriovenous (AV) fistula utilizing cathet
er-directed techniques and stents. Methods: Stent-graft AV fistulas we
re offered on an experimental basis to 8 patients who had a history of
multiple failed access procedures or very small arm veins unsuitable
for standard vascular access techniques. The device consisted of a bal
loon-expandable Palmaz stent attached to the designated venous end of
a polytetrafluoroethylene graft, The balloon-mounted stent-graft was i
nserted into the brachial vein through an arteriotomy and advanced ove
r a guidewire into the axillary vein. After the stent-graft was deploy
ed, the arterial anastomosis was completed in standard surgical fashio
n using an end-to-side anastomosis of the graft to the brachial artery
. Results: The stent-graft was inserted successfully in all patients,
but there were two early failures. The first resulted from a steal phe
nomenon secondary to high flows through the stent-graft, necessitating
ligation of the fistula. Another stent-graft was placed too periphera
lly in the upper arm, and the stainless steel stent was crushed by ext
ernal compression. Three of the 6 remaining grafts were patent for ove
r 1 year, and 2 grafts are still functioning at 22 and 13 months. Conc
lusions: Endoluminal stent-grafts can be successfully inserted into th
e axillary vein for creation of an AV fistula and remain patent for 2
years or more. This method may be most useful in patients with very sm
all, unusable arm veins or multiple failed AV grafts.