CHICAGO—Stent-graft exclusion of symptomatic pseudoaneurysms in dialysis access fistulae outflow veins is a promising therapy that allows preservation of surgical dialysis access that would otherwise have to be abandoned, according to researchers.
In a small retrospective study, six of seven patients had symptomatic relief and were able to resume using the stent-grafted fistulae.
“The standard of care is surgery, but perhaps we can offer an alternative to preserve that access site,” said lead investigator Mark Rapoport, MD, an interventional radiology fellow at Northwestern Memorial Hospital in Chicago. “We don’t want to burn all our access sites. We don’t want to walk away without a fight. We need to save every access site for as long as we can.”
Dr. Rapoport, who presented the study findings at the Society of Interventional Radiology’s 2011 Annual Scientific Meeting, said significant money and resources are spent annually trying to preserve hemodialysis access. The primary treatment of symptomatic pseudoaneurysms arising from native fistulae is surgical. Stent grafts, however, have been well described in the treatment of pseudoaneurysms arising from dialysis grafts.
The researchers placed 17 stent grafts in 11 pseudoaneurysms in seven patients who developed symptomatic dialysis fistula pseudoaneurysms within existing dialysis fistulae outflow veins. Among the indications for treatment were progressive pseudoaneurysm enlargement, unremitting pain, and overt rupture. For this investigation, symptoms and fistula function prior to and following stent grafting were assessed through chart review. Pseudoaneurysm exclusion was assessed through follow-up fistulography.
Patients ranged in age from 34 to 64 years; at the time of stent grafting, the fistulae ranged in age from three months to 19 years. Four patients had a single pseudoaneurysm, two had two pseudoaneurysms, and one had three pseudoaneurysms. At the time of stent grafting, two pseudoaneurysms were overtly ruptured.
The technical success rate was 100%. Five of the seven patients resumed using the dialysis fistula for dialysis following stent grafting; five had symptom relief.
One patient developed a pressure-related wound over the excluded pseudoaneurysm within three weeks after stent grafting and required resection of the stent graft with ligation of the fistula. An acute perifistula hematoma developed in another patient after dialysis access following stent graft placement, but the patient was able to resume using the fistula after hematoma resolution.