Covered Stents at Cannulation Sites in Recurrent Stenosis in Vascular Access

Vascular access life may be prolonged by treating vascular access stenosis with covered stents at cannulation sites according to review findings published in the Journal of Endovascular Therapy.

Researchers evaluated the results of covered stent placement at cannulation sites to salvage failing vascular access. They conducted a retrospective review that included 11 of 856 patients from a prospectively maintained database in a single-center cohort study with chronic renal dysfunction requiring hemodialysis. Patients were treated between November 2004 and December 2021.

Among the 11 patients who received covered stent placement at cannulation sites for salvaging failing vascular access between 2018 and 2021 (median age at stent placement, 63.0 years; 7 women), there were 4 procedures in patients with brachiocephalic arteriovenous fistulae, 5 in patients with an arteriovenous graft, and 2 in patients with a basilic vein transposition. There were 8 patients who received a covered stent due to recurrent stenosis, 2 due to an acute occlusion, and in 1 case the repair of a damaged polytetrafluoroethylene arteriovenous graft was accomplished with a covered stent.

The researchers found that at 6 months the primary patency after stent placement was 40.9%, at 12 months primary-assisted patency was 79.5%, and at 24 months secondary patency was 80%. They noted the intervention rate per patient-year was not statistically different before (3.8 [IQR=9.5] interventions per year) or after (2.5 [IQR=3.0] interventions per year; P =.280) covered stent placement. They reported no significant problems observed during dialysis sessions following stent placement.

Review limitations include the underpowered sample size and the retrospective study design.

“Based on our results, treating vascular access stenosis at cannulation sites with covered stents should be considered to prolong vascular access life with similar intervention rates and acceptable patency rates in these fragile hemodialysis patients,” the study authors wrote.

Reference

Drouven JW, Bruin C, van Roon AM, et al. Use of covered stents in cannulation sites as a last option to salvage failing vascular access. J Endovasc Ther. Published online August 16, 2022. doi:10.1177/15266028221116745