Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts

Abstract

In this study, percutaneous revision of venous anastomotic stenosis in patients with a prosthetic hemodialysis graft was improved with the use of a stent graft, which appears to provide longer-term and superior patency and freedom from repeat interventions than standard balloon angioplasty. (ClinicalTrials.gov number, NCT00678249.)

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

“…Sixmonth access circuit patency rates among AVFs and AVGs in our study were observed at 47.1 and 34.9 %, respectively. Prior published studies reported 6-month access primary patency rates between 40 and 57 % among AVFs [6,12,14] and 20 and 40 % among AVGs [5,6,15]. Our findings are comparable to these aforementioned studies.…”

“…Although the small sample size of our population may limit interpretation of significance, a prior randomized prospective study with larger sample size (n = 93) demonstrated similar results [5].…”

“…Technical success rates within several retrospective studies defined as \30 % residual stenosis post-PTA have ranged from 75 to 89 % for autogenous fistulas [12][13][14]. In a prospective study evaluating balloon angioplasty within prosthetic grafts [5], technical success of 73 % was achieved where proper core lab determination was performed rather than an ''eye-ball'' assessment.…”

“…Multiple published studies, and the SIR reporting guidelines in dialysis interventions, define technical or anatomic success of percutaneous transluminal angioplasty (PTA) as \30 % residual stenosis following balloon angioplasty [1][2][3][4][5][6]. This endpoint that was initially adopted by three papers from the anatomic criteria used for arterial angioplasty [7][8][9]; however, there is a relative paucity of data validating its use for venous angioplasty in hemodialysis accesses.…”

Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: Final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472)

“…However, short-term restenosis leading to increased re-intervention and access thrombosis events has limited its clinical efficacy [1]. In 2010, results from a multi-center randomized trial reported that self-expandable stent graft deployment is a valid alternative that may outweigh traditional BA for the treatment of venous juxta-anastomotic stenosis of AVGs [3].…”