Metallic stents deployed in synthetic arteriovenous hemodialysis grafts

OBJECTIVE. The purpose of our study was to review the success of metallic s tent treatment of intragraft stenoses in patients with synthetic arterioven ous hemodialysis grafts. MATERIALS AND METHODS. Between May 1993 and May 1997, 19 metallic stents we re placed in 11 patients (seven women, four men; age range, 41-83 years) to treat elastic intragraft stenoses or graft dissections. Before stent place ment, all patients had experienced multiple episodes of graft thrombosis, h ad very limited vascular access for hemodialysis, and were considered poor surgical candidates. RESULTS. The technical success rate was 100%, and there were no procedural complications. Using life-table analysis, we found primary patency to be 36 % at 6 months after stent placement, 12% at 12 months, and 12% at 18 months . Secondary patency was 91% at 6 months after stent placement, 71% at 12 mo nths, and 47% at 18 months. The mean and median patencies per intervention were 4.2 and 3.6 months, respectively. Mean and median secondary graft pate ncies were both 14 months (range, 3 days-32 months). Puncture through the s tents occurred during dialysis, causing stent distortion and fracture. Eigh t stents had a linear fracture suggesting compression contributed to the st ent distortion. No clinically evident complications related to stent placem ent occurred. CONCLUSION. Metallic stent deployment can salvage access in synthetic arter iovenous grafts by alleviating intragraft stenoses. Patency of intragraft s tents is similar to venous stents used to treat other hemodialysis-related stenoses; however, fracture of Wall-stents occurs with prolonged graft use, especially in areas of needle punctures.