Treatment of Hemodialysis Access Rupture during PTA with Wallstent Implantation

Surgical revision of complicated false and true vascular access–related aneurysms

“…Surprisingly, published data on this are scarce and mainly refer to endovascular data (usually from small series) dealing with complicated AVA-related aneurysms. [12][13][14][15][16][17][18][19][20][21][22][23][24] False and true aneurysms can complicate all types of AVA. 4 In false aneurysms, no vessel or graft is present in the wall of the dilatation, whereas in true aneurysms, the flow in an otherwise normal graft or autogenous fistula continues to increase, and the vein or graft may continue to enlarge.…”

“…24 In contrast, uncovered stents implanted for false aneurysms definitely lose the opportunity for complete occlusion in most cases. 16 In addition to the structural differences between covered stents leading to different behavior after venipuncture, the absence of a considerable decrease in aneurysm size after the insertion of a covered stent may limit the cannulation zone, especially for large aneurysms. Vesely 24 reported that two of 11 patients with Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) covered stents inserted in prosthetic fistulas still had large excluded false aneurysms that interfered with needle cannulation.…”

“…41 Several endovascular reports published since 1992 have described the intragraft percutaneous deployment of covered stents as an alternative treatment for excluding AVArelated aneurysms while maintaining patency of a AVA (Appendix Table VII online only. [12][13][14][15][16][17][18][19][20][21][22][23][24] However, the mean study sample size was only 5.8 patients (range, 1-18 patients), and the follow-ups were very limited. Surprisingly, there is no report in the literature on the effect of revision surgery in patients who present purely with complicated true or false AVA-related aneurysms.…”

“…11 Although small series have addressed the repair of autogenous and graft-related false aneurysms, they have exclusively used endovascular approaches. [12][13][14][15][16][17][18][19][20][21][22][23][24] In this study, we investigated the effect of revision operations on the postintervention primary patency in 44 hemodialysis patients who presented with complicated true or false aneurysms either as sole lesions or combined with other access-related complications. The postintervention primary patency was also compared between groups of patients and between groups of patients with different AVA characteristics before and after intervention.…”

Placement of Hemodialysis Catheters Through Stenotic or Occluded Central Thoracic Veins

“…Potential complications of stent deployment in the CTV system include venous rupture, stent misplacement, and stent migration [22,23]. Minor venous ruptures during the percutaneous transluminal angioplasty procedure are reported to be frequent [24]. However, they usually seal spontaneously or with prolonged low-pressure inflation of the balloon.…”