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INTRODUCTION: Not all newly created arterio-venous fistulas (AVF) successfully mature and develop into a functioning access for hemodialysis. Percutaenous balloon angioplasty (PTA) and balloon assisted maturation (BAM) have been utilized to either treat flow limiting stenoses or to promote and accelerated maturation. We reviewed our experience rescuing unusable AVFs by conversion to a functional access using the percutaneous placement of a stent graft.
METHODS: Clinical data of 12 patients (7 women; overall mean age 63 years, range 46-81 years) with a non-usable upper extremity arterio-venous fistula underwent percutaneous revision using Viabahn stent grafts . There were 6 brachio-cephalic, 3 brachio-basilic with vein transposition, and 3 brachio-brachial with vein transposition AVFs. Relevant clinical variables, imaging studies and treatment variables were analyzed.
RESULTS: Ninety -two percent of the patients had hypertension, 83% were diabetics, and 67% had at least one previous PTA of the AVF. All patients had at least 2 or more stenoses within the fistula and had failed PTA and had a significant segment < 6 mm in diameter. Stent grafts used were 6 mm, 7mm, and 8mm in diameter in 33.3%, 58.3%, and 8.3% of patients, respectively. The average length of the stent graft was 10 cm (range 5-15 cm). All stent grafts were post balloon dilated at the time of placement. All AVFs were salvaged and patients were able to maintain functional use of their access with cannulation occurring through stent graft.
CONCLUSIONS: Stent grafts offer a simple and percutaneous solution to rescue, preserve and convert an unusable AVF into a functioning hemodialysis access.