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Jeon, Shin, Ohm, and Ahn: Stent Graft Placement for Dysfunctional Arteriovenous Grafts
Interventional Radiology

Journal of the Korean Society of Radiology 2015; 73(1): 11-17.

Published online: 24 June 2015

DOI: https://doi.org/10.3348/jksr.2015.73.1.11

Stent Graft Placement for Dysfunctional Arteriovenous Grafts

Gyeong Sik Jeon, MD1, Byung Seok Shin, MD2, Joon Young Ohm, MD2, Moonsang Ahn, MD3

1Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam, Korea.

2Department of Radiology, Chungnam National University Hospital, Daejeon, Korea.

3Department of Surgery, Chungnam National University Hospital, Daejeon, Korea.

Corresponding author: Byung Seok Shin, MD. Department of Radiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel. 82-42-280-7333, Fax. 82-42-253-0061, starzan@chol.com

Received 23 September 2014       Accepted 21 April 2015

Copyright © 2015 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts.

Materials and Methods

Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis.

Results

Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency.

Conclusion

Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

Keywords: Stents and Prostheses, Grafts, Interventional Procedures, Arteriovenous Grafts, Hemodialysis, Veins, Stenosis or Obstruction

Figures and Tables

Fig. 1

A 68-year-old man with a dysfunctional arteriovenous graft.

A. A venogram reveals thrombosis (arrowheads) related with the stenosis at the venous anastomosis (arrow).
B. Follow-up venogram obtained 18 months later after expanded poly-tetrafluoroethylene stent graft placement (8 mm in diameter × 70 mm in length) reveals preserved patency of the arteriovenous graft (AVG) and mild stenosis at the end of the stent graft (arrow). Patency of the AVG is pre-served until 1351 days (45 months) after repeat balloon angioplasty.
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Fig. 2

Primary (solid line) and secondary (dotted line) patency curve of arteriovenous grafts treated with stent graft placement.

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Fig. 3

A 55-year-old woman with a dysfunctional arteriovenous graft.

A. A follow-up venogram obtained 4 months later after expanded polytetrafluoroethylene stent graft placement (8 mm in diameter × 40 mm in length) across the elbow joint reveals mild stenosis at the end of the stent graft and long segmental stenosis in the drainage vein (arrowheads). After balloon angioplasty, we have to place a bare metal stent (8 mm in diameter × 120 mm in length) from the mid-portion of the stent graft to the drainage vein because of elastic recoil and focal venous laceration.
B. A follow-up venogram obtained 7 months later reveals restenosis in the stent graft and in the more proximal drainage vein beyond the bare stent, necessitating repeat balloon angioplasty.
C. Fracture and disruption of stent wire is suspected at the mid-portion of the stent graft (arrows). Fracture may have been related to the strength of the bare metal stent and its position (across the elbow joint).
D. A venogram after repeat angioplasty and additional bare metal stent reveals patent lumen without residual stenosis. Patency of the arteriovenous graft is preserved until 854 days (28 months).
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Table 1

Primary and Secondary Patency in Relation to Patient and Procedural Data

jksr-73-11-i001
Characteristics Primary Patency Secondary Patency p-Value Primary, Secondary
Age ≥ 60 years (n = 5) 388 ± 173 682 ± 207 0.860, 0.977
< 60 years (n = 6) 330 ± 109 782 ± 199
Sex Male (n = 4) 391 ± 111 733 ± 172 0.890, 0.647
Female (n = 7) 347 ± 157 728 ± 253
Diabetes Diabetics (n = 8) 285 ± 68 783 ± 148 0.319, 0.572
Non-diabetics (n = 3) 527 ± 302 605 ± 347
Antiplatelet agent Medication (n = 5) 389 ± 150 850 ± 183 0.807, 0.559
No medication (n = 6) 313 ± 119 654 ± 209
Graft location Left arm (n = 8) 402 ± 132 882 ± 161 0.579, 0.060
Right arm (n = 3) 269 ± 144 424 ± 192
Graft location Forearm (n = 7) 264 ± 60 641 ± 112 0.216, 0.334
Upper arm (n = 4) 498 ± 227 840 ± 297
Graft configuration Loop (n = 8) 382 ± 128 747 ± 141 0.882, 0.702
Straight (n = 3) 312 ± 182 704 ± 374
Stenosis length ≥ 4.0 cm (n = 4) 301 ± 79 458 ± 89 0.563, 0.099
< 4.0 cm (n = 7) 411 ± 160 871 ± 173
Graft thrombosis Thrombotic (n = 9) 335 ± 108 751 ± 156 0.543, 0.634
Non-thrombotic (n = 2) 510 ± 0 510 ± 0
Across the joint Yes (n = 6) 255 ± 61 628 ± 120 0.152, 0.272
No (n = 5) 531 ± 216 892 ± 264
Stent fracture Yes (n = 2) 649 ± 409 1062 ± 184 0.252, 0.445
No (n = 9) 291 ± 74 658 ± 158

Data are presented as days (mean survival time ± standard error). Continuous data have been converted to categorical data according to the mean value.

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