Patency of Wallstents placed across the venous anastomosis of hemodialysis grafts after percutaneous recanalization

PURPOSE: To determine the patency of Wallstents placed across the venous anastomosis of prosthetic bridge grafts after percutaneous graft recanalization.

MATERIALS AND METHODS: Wallstents were placed across 26 lesions at the venous anastomosis of polytetrafluoroethylene (PTFE) grafts in 25 patients (11 men, 14 women; age range, 29-83 years; mean age, 65.4 years) after pulse-spray pharmacomechanical thrombolysis. Indications for stent deployment included acute angioplasty failure, rapid restenosis, and vessel perforation.

RESULTS: The initial success rate was 100%. The mean primary graft patency rates (+/- standard error) at 3 and 6 months were 34% +/- 9 and 27% +/- 9, respectively. Secondary patency rates were 77% +/- 8 at 3 months, 72% +/- 9 at 6 months, and 50% +/- 10 at 12 months. Eight of the 26 grafts continued to be used for hemodialysis at the end of follow-up.

CONCLUSION: After angioplasty failure or vessel perforation, Wallstent placement at the venous anastomosis of recanalized PTFE grafts can salvage hemodialysis access function. The results of this study indicate that the 1-year secondary patency rate of these grafts is 50%, which approaches the reported rates of patency after balloon dilation as part of percutaneous graft recanalization.