Long Term Results and Pattern of Recurrence after Bare Metal Stent Placement in the Treatment of Refractory or Recurrent Venous Anastomotic Stenoses of Arteriovenous Graft

Abstract

Objective: We investigated long term results and pattern of recurrence after bare metal stent (BMS) placement in the treatment of resistant and recurrent venous anastomotic stenoses in arteriovenous graft (AVG) and elucidated the pattern of recurrence. Methods: Fifty-eight patients (30 failing and 28 failed access) who underwent first BMS placement for venous anastomotic stenosis of AVG were included. Operative results and patency of hemodialysis access and freedom from target lesion revascularization (TLR) were investigated retrospectively. Places of recurrence after first BMS placement were analyzed from radiology records. Results: All BMS were self-expanding stent. Operative time was 26±10 minutes for failing cases, and 47±17 minutes for failed cases. Initial success was 100%. Intraoperative complication (extravasation of contrast medium) occurred in 3 cases (5.1%). Three month-postintervention primary patency before and after first BMS placement was 21.1% and 75.6% respectively (p<0.001). Postintervention primary, assisted primary, secondary patency, and freedom from TLR were 51.7%, 73.6%, 96.5% and 61.8% at 6 months, and 30.3%, 67.3%, 96.5% and 35.2% at 1 year, respectively. About half of recurrence after BMS placement developed in-stent and 17% of recurrence developed remote downstream from the BMS. Conclusions: BMS placement is safe and effective treatment for recurrent or resistant venous anastomotic stenoses in AVG. During the observation period, only 17% of recurrence after first BMS placement developed remote downstream from the BMS.