Treatment of Hemodialysis Graft Pseudoaneurysms with Stent Grafts: Institutional Experience and Review of the Literature

Abstract

Hemodialysis access grafts are an important component of the treatment of patients with renal failure. Because access sites are limited, maximizing graft lifespan is of major importance to dialysis patients. Pseudoaneurysm formation is a rare, but important complication potentially limiting the longevity of dialysis grafts. With rapidly advancing technology, placement of stent grafts in patients with end-stage renal disease is an important step in prolonging the life of the graft. We conducted a review of the literature regarding stent-graft use for hemodialysis access. In addition, we looked at our experience utilizing the Viabahn 1 (W. L. Gore & Associates, Newark, DE) stent graft in pseudoaneurysm repair. Our patients achieved primary patency of their grafts for 1, 5, and 9 months, respectively. No complications related to stent-graft implementation have been encountered in six stent-graft implants over the course of 29 months.

Stent graft treatment for hemodialysis access aneurysms

“…13 The different types of covered stents that have been used in endovascular treatment have been previously described. 12,[14][15][16][17][18][19] Endovascular access aneurysm repair is usually performed as an outpatient procedure, 20 and early dialysis venipuncture is encouraged to return the patient to an uninterrupted dialysis regimen. 15,17 Although not specifically designed for hemodialysis needle puncture, commercially available covered stent devices can endure repeated punctures to extend the use of the access for hemodialysis for many years (Fig 3).…”

“…18,20 However, if the thrombus persists for many months before being absorbed, the stent-excluded aneurysm may interfere with available puncture sites. The A brachial axillary graft pseudoaneurysm was stented with a Hemobahn stent graft.…”

Endovascular treatment of arteriovenous graft pseudoaneurysms, indications, complications, and outcomes: A systematic review

“…Endovascular treatment allows continuous use of the AVG without the need for a tunneled catheter as would be required while recovering from a surgical revision. If unsuccessful, endovascular treatment does not preclude surgical revision …”

Kraujagyslinės Hemodializės Jungtys: Klinikinis Atvejis Ir Apžvalga

“…Rekomenduojama pradėti planuoti ir ruoštis jungties formavimui, kai pacientui nustatoma 4 stadijos lėtinė inkstų liga ( GFR = 15-29 mL/min./1.73 m 2 ), kai iki hemodializės pradžios lieka ne < 3-6 mėnesiai arba kai iki planuojamos hemodializės pradžios lieka ne daugiau kaip 1 metai [3,6]. Svarbu pabrėžti, jog kai kuriems pacientams sunku tiksliai numatyti IFN progresavimą, todėl reikalingi tolesni tyrimai optimaliam jungties sukūrimo laiko nustatymui [7]. Labai svarbus ultragarsinis kraujagyslių tyrimas dopleriu ir dvigubu skenavimu -taip galima rasti trombozės ir stenozės paveiktas venas, kurios nėra tinkamos AVF formuoti [3,6].…”

“…Jas galima "išjungti" stentavimu, taip prailginant jungties gyvavimą [7]. PTFE protezais suformuotoms jungtims rekomenduojama tokia pati kaip ir natyvinių AVF funkcionavimo diagnostika ir reguliarus tikrinimas [2,3].…”