Coated Stent Fixes AV Access Rupture

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Bart Dolmatch, MD
Bart Dolmatch, MD

Circuit patency for AV access similar for bare and Dacron-covered stents.

 

WASHINGTON, D.C.—The fluency expanded polytetrafluoroethylene (ePTFE)-coated stent is effective for treating angioplasty-related extravasation in arteriovenous (AV) grafts and fistulae. Data showed a high rate of technical success with this approach, but primary patency rates were low.

 

Researchers studied 21 patients who were treated for angioplasty-related extravasation. Eleven patients had arteriovenous (AV) grafts and 10 had AV fistulae. Use of the Fluency-covered stent extravasation allowed all 21 pa-tients to return to hemodialysis with a working access.

 

The 180-day primary patency rate was 20% and the 180-day cumulative circuit patency rate was 65%, comparable to that reported for bare stents and Dacron-covered stents. Findings were reported here at the Society of Interventional Radiology annual meeting.

 

For their study, researchers at the University of Texas Southwestern Medical Center and the Lincoln Hypertension and Nephrology practice in Lincoln, Neb., reviewed the technical and patency rates using the Fluency-covered stent for treating venous rupture encountered during percutaneous hemodialysis intervention. This stent is a tracheobronchial device (Bard Peripheral Access) that consists of a self-expanding stent and ePTFE.

 

The Fluency stent has been used off-label to treat hemodialysis access problems, but there have been few reports on how successful it is for this indication.

 

The researchers reviewed all patients treated for angioplasty-induced AV access rupture using the Fluency stent in 2004 and 2005. The 21 patients in this group underwent 21 procedures. The location of extravasation was the outflow or cannulation venous segment (11 cases), cephalic arch (three cases), AV graft anastomosis (six cases), and intragraft (one case).

 

All procedures were technically successful, and 20 of the 21 circuits remained patent beyond the first week after intervention. Six patients (29%) lost primary patency in the first 30 days whereas seven patients (33%) maintained primary patency beyond 90 days.

 

Lead investigator Bart Dolmatch, MD, professor of radiology at the University of Texas Southwestern Medical Center in Dallas, said the findings are important because they support the use of covered stents, and suggest that patency rates are acceptable with the Fluency-covered stent.

 

No severe complications were observed in any patient, and all patients returned to dialysis without issue. Dr. Dolmatch said he believes the ePTFE covering may seal the site of extravasation to prevent pseudo-aneurysm formation, and perhaps provide a surface that is more resistant to thrombosis compared with injured vein. No patient developed signs of inflammation related to implantation of the Fluency ePTFE-covered stents, unlike prior reports of polyethylene-covered stents.

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