Vasc Spec Int.  2019 Dec;35(4):225-231. 10.5758/vsi.2019.35.4.225.

Use of Paclitaxel Eluting Stents in Arteriovenous Fistulas: A Pilot Study

Affiliations
  • 1Department of Surgery, Prince of Wales Hospital, Australia. shannondthomas@gmail.com
  • 2Department of Vascular Surgery, Westmead Hospital, Australia.
  • 3Faculty of Medicine, University of New South Wales, Australia.
  • 4The Vascular Institute, Prince of Wales Hospital, Sydney, Australia.

Abstract

PURPOSE
We report short-term patency outcomes of a proof of concept study conducted to determine the efficacy of drug-eluting stent (DES) for the treatment of arteriovenous fistula (AVF) stenosis in hemodialysis patients.
MATERIALS AND METHODS
This is a single-center, retrospective observational study involving 10 patients with AVF dysfunction treated with DESs between January 2017 and December 2017. The primary outcome was AVF patency confirmed by sonographic and clinical assessment at 1 month and 6 to 9 months after treatment.
RESULTS
A total of 12 DESs were deployed in 10 patients with dysfunctional AVF (radiocephalic: 7, brachiocephalic: 3). During the early follow up (mean: 28.6 days), primary access circuit and DES patency was 100%, with an average volume flow rate of 886.4 mL/min. Nine patients were available for short-term follow up (mean: 202.4 days; 1 unrelated death), with a mean volume flow rate of 1,048.9 mL/min. The primary DES patency was 7/9 (77.8%), and 3 patients required angioplasty at other parts of the circuit (primary access circuit patency: 4/9 [44.4%]). The assisted primary access circuit patency was 77.8%. In 2 patients, the ultrasound revealed that the DESs were thrombosed without any antecedent stenosis; they were salvaged with angioplasty. Both patients previously underwent 2 DESs implanted and recently stopped dual antiplatelet therapy. B-mode sonographic assessment at all timepoints showed minimal intimal ingrowth on the stent struts.
CONCLUSION
This study demonstrates acceptable short-term patency for DESs in the treatment of AVF stenosis. Dual antiplatelet therapy is probably mandatory in the short term.

Keyword

Arteriovenous fistula; Fistula; Vascular access; Drug-eluting stents
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