TREATMENT OF HEMODIALYSIS ACCESS RUPTURE DURING PTA WITH WALLSTENT IMPLANTATION

PURPOSE: To report the authors' experience in treatment of ruptures co mplicating percutaneous transluminal angioplasty (PTA) of hemodialysis access with implantation of a Wallstent, MATERIALS AND METHODS: Betwe en January 1, 1990, and October 1, 1995, the authors performed 2,414 P TAs of angioaccesses, A severe rupture occurred in 40 (1.7%) of these procedures and was treated by means of stent placement. Wallstents wer e implanted in 37 of these ruptures. The angioaccesses comprised 22 gr afts and 15 fistulas, The indications for stent placement were four is olated pseudoaneurysms and 33 cases of bleeding: 15 major leaks, five moderate leaks that persisted despite prolonged inflation at low press ure, seven leaks associated with greater than 50% residual stenosis, f our leaks associated with pseudoaneurysm, and two leaks associated wit h both greater than 50% residual stenosis and pseudoaneurysm Seventeen ruptures were located on a vein, 19 on the venous anastomosis of a gr aft, and one on a graft itself. RESULTS: Stent placement stopped the b leeding immediately in 28 cases and after prolonged inflation within t he stent in four cases. Residual bleeding required implantation of a c overed Cragg stent within the Wallstent in one case. A pseudoaneurysm was still visible at the end of the intervention in 11 cases. Two comp lications occurred; one hematoma was drained surgically and one access occluded on day 2, Follow-up angiography showed a small pseudoaneurys m in only one patient with impaired platelet function, The primary and secondary patency of the angioaccesses were 48% and 86% at 1 year, re spectively. CONCLUSION: Wallstent implantation is very effective for b oth immediate and long-term treatment of rupture of angioaccess during PTA.