Viabahn stent for hemodialysis shunt: efficacy,long segment recanalization and prognostic factors for reintervention

Abstract

Introduction:

The study evaluated the Heparin Bioactive Surface (HBS) Viabahn Stent (W.L. Gore & Associates, Flagstaff, Arizona) efficacy in the maintenance or re-establishment of hemodialysis.

Materials and methods:

Fifty HBS Viabahn stents deployed in 37 consecutive patients with hemodialysis dysfunction from January 2008 to May 2016 were evaluated in a single-institution retrospective review.

Outcomes were stent patency intended as primary circuit patency (PP), assisted primary patency (APP), target lesion primary patency (TLPP) and secondary patency (SP).

Moreover, the risk factor analysis for hemodialysis dysfunction that required reintervention was performed. A subgroup analysis was conducted to assess patency of Viabahn stent to treat peripheral venous long segment obstruction (LSO).

Results:

Overall Kaplan-Meyer PPs were 60% at 12 months and 42% at 24 months. Overall TLPP estimated rates were 68% and 49% at 12 and 24 months, respectively. The corresponding SP rates were 85% and 78% at the same period. Estimated PP rates at 12 and 24 months for stent placement after peripheral venous long segment recanalization procedure were 53% and 31%, respectively. Corresponding SP rates were 82% and 68%, respectively. The APP rates were 79% at 12 months and 61% at 24 months.

Female sex, access age and thrombosis were associated with reduced primary patency.

Conclusions:

Considering the high rates of PP, TLPP, APP and SP, Viabahn stents have been proven effective in maintaining or re-establishing the hemodialysis access. Moreover, stent placement after recanalization of LSO of venous out-flow represented a valid approach to rescue a dysfunctional fistula that would otherwise be abandoned.

Keywords

Assisted primary patency Long segment recanalization Primary circuit patency Primary target lesion patency Secondary patency

Get full access to this article

View all access options for this article.

References

Trinh

Khoi N.

Wilson

Samuel E.

Gordon

Ian L.

Russell

Post-intervention patency: a comparison of stenting versus patch angioplasty for dysfunctional hemodialysis access sites. Ann Vasc Surg. 2016;33:120–125.

Davila Santini

Etkin

Nadelson

et al . Stent-grafts improve secondary patency of failing hemodialysis grafts. J Vasc Access. 2012;13(1):65–70.

Rajan

Falk

. a Randomized Prospective Study Comparing Outcomes of Angioplasty versus VIABAHN stent-graft placement for cephalic arch stenosis in dysfunctional hemodialysis accesses. J Vasc Interv Radiol. 2015;26(9):1355–1361.

Gray

Sacks

Martin

Trerotola

. Society of interventional Radiology Technology Assessment Committee. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol. 2003;14:S433–S442.

Chan

Miller

Valji

Kuo

. Evaluation of expanded polytetrafluoroethylene-covered stents for the treatment of venous outflow stenosis in hemodialysis access grafts. J Vasc Interv Radiol. 2011;22(5):647–653.

Davidson

Hackerman

Kapadia

Minhajuddib

. Heparin bonded hemodialysis e-PTFE grafts result in 20% clot free survival benefit. J Vasc Access. 2009;10(3):153–156.

Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S176–S273.

Haskal

Trerotola

Dolmatch

et al . Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010;362(6):494–503.

Vesely

DaVanzo

Behrend

Dwyer

Aruny

. Balloon angioplasty versus Viabahn stent graft for treatment of failing or thrombosed prosthetic hemodialysis grafts. J Vasc Surg. 2016;64(5):1400–1410.e1.

10.

Joachim

Yevzlin

Shin

Astor

Chan

. A meta-analysis of stent placement vs. angioplasty for dialysis vascular access stenosis. Semin Dial. 2015;28(3):311–317.

11.

Shemesh

Goldin

Zaghal

et al . Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg. 2008;48:1524–1531.

12.

Kim

Tandberg

Rosenberg

Miller

Suhocki

Smith

. Outcomes of prosthetic hemodialysis grafts after deployment of bare metal versus covered stents at the venous anastomosis. Cardiovasc Intervent Radiol. 2012;35(4):832–838.

13.

Chan

Bedi

Sanchez

et al . Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistulae. Clin J Am Soc Nephrol. 2008;3(3):699–705.

14.

Karnabatidis

Kitrou

Spiliopoulos

et al . Stent-grafts versus angioplasty and/or bare metal stents for failing arteriovenous grafts: a cross-over longitudinal study. J Nephrol. 2013;26(2):389–395.

15.

Vesely

Amin

Pilgram

. Use of stents and stent grafts to salvage angioplasty failures in patients with hemodialysis grafts. Semin Dial. 2008;21(1):100–104.

16.

Bent

Rajan

Tan

et al . Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas. J Vasc Interv Radiol. 2010;21(4):496–502.

17.

Ayez

Fioole

Aarts

et al . Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates. J Vasc Surg. 2011;54(4):1095–1099.

18.

Schmelter

Raab

Lazarus

Ruppert

Vorwerk

. Outcomes of AV fistulas and AV grafts after interventional stent-graft deployment in haemodialysis patients. Cardiovasc Intervent Radiol. 2015;38(4):878–886.

19.

Perera

Mueller

Kubaska

et al . Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg 2004;18(1):66–73.

20.

Akoh

. Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access. 2009;10(3):137–147.

21.

Neuen

Gunnarsson

Webster

Baer

Golledge

Mantha

. Predictors of patency after balloon angioplasty in hemodialysis fistulas: a systematic review. J Vasc Interv Radiol. 2014;25(6):917–924.

22.

Quaretti

Galli

Moramarco

et al . Stent grafts provided superior primary patency for central venous stenosis treatment in comparison with angioplasty and bare metal stent: a retrospective single center study on 70 hemodialysis patients. Vasc Endovascular Surg. 2016;50(4):221–230.

23.

Byrne

Joner

Kastrati

. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J. 2015;36:3320–3331.

24.

Yan

Clark

Mondschein

et al . Outcomes of percutaneous interventions in transposed hemodialysis fistulas compared with non-transposed fistulas and grafts. J Vasc Interv Radiol. 2013;24:1765-72. quiz: 1773.

25.

Rajan

Falk

. A randomized prospective study comparing outcomes of angioplasty versus Viabahn stent-graft placement for cephalic arch stenosis in dysfunctional hemodialysis accesses. J Vasc Interv Radiol. 2015;26:1355–1361.

26.

WL Gore & Associates, Inc. Gore Vascular Access Revision with GORE VIABAHN Endoprosthesis vs Percutaneous Transluminal Angioplasty (REVISE) Study. ClinicalTrials.gov. Bethesda, MD: National Library of Medicine; 2013. Available from: http://clinicaltrials.gov/show/NCT00737672. Accessed Oct 11, 2017.