023 - Treatment of intragraft stenosis in hemodialysis grafts with Supera stents: A retrospective study
Hung Hsing Chao, N/A – Dr, Department of Cardiovascular Surgery; Ming Jen Lu, N/A – Dr, Department of Cardiovascular Surgery
Purpose: To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses.
Material and Methods: Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded.
Results: The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6–36)months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12months, respectively. Access circuit secondary patency rates were 100% at 6 and 12months and 89% at 18months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6months and 75% at 12months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation.
Conclusions: The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.