J Korean Soc Radiol.  2015 Jul;73(1):11-17. 10.3348/jksr.2015.73.1.11.

Stent Graft Placement for Dysfunctional Arteriovenous Grafts

• Jeon GS
• Shin BS
• Ohm JY
• Ahn M

• KMID: 1823917
• DOI: http://doi.org/10.3348/jksr.2015.73.1.11

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.

MeSH Terms

Aneurysm, False
Angioplasty
Blood Vessel Prosthesis*
Humans
Kaplan-Meier Estimate
Lacerations
Polytetrafluoroethylene
Renal Dialysis
Retrospective Studies
Transplants*
Polytetrafluoroethylene

Figure

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  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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