Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

Journal Article · Sat Oct 15 00:00:00 EDT 2011 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-010-0019-4· OSTI ID:21608590

Kundu, Sanjoy; Modabber, Milad ^[1]; You, John M ^[2]; Tam, Paul; Nagai, Gordon; Ting, Robert ^[3]

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1. Scarborough General Hospital-General Division, Department of Medical Imaging (Canada)
2. Scarborough General Hospital-General Division, Department of Vascular Surgery (Canada)
3. Scarborough General Hospital-General Division, Department of Nephrology (Canada)

Purpose: To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions. Materials and Methods: Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50-83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14), and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria). Results: Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9-7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4-8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14). Conclusions: This PTFE encapsulated stent graft demonstrates encouraging intermediate-term patency results for central vein occlusions. Further prospective studies with long-term assessment and larger patient populations will be required.

• OSTI ID: 21608590
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 34, Issue 5; Other Information: DOI: 10.1007/s00270-010-0019-4; Copyright (c) 2011 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
EDEMA
GRAFTS
KIDNEYS
MALES
NICKEL ALLOYS
PATIENTS
SAFETY
TEFLON
TITANIUM ALLOYS
VEINS
ALLOYS
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
FLUORINATED ALIPHATIC HYDROCARBONS
HALOGENATED ALIPHATIC HYDROCARBONS
MATERIALS
ORGANIC COMPOUNDS
ORGANIC FLUORINE COMPOUNDS
ORGANIC HALOGEN COMPOUNDS
ORGANIC POLYMERS
ORGANS
PATHOLOGICAL CHANGES
PETROCHEMICALS
PETROLEUM PRODUCTS
PLASTICS
POLYETHYLENES
POLYMERS
POLYOLEFINS
POLYTETRAFLUOROETHYLENE
SYMPTOMS
SYNTHETIC MATERIALS
TRANSITION ELEMENT ALLOYS
TRANSPLANTS