Use of stents and stent grafts to salvage angioplasty failures in patients with hemodialysis grafts.

To determine the efficacy of using stents and stent grafts for treatment of hemodialysis graft-related stenoses which have failed angioplasty. This retrospective study was composed of 51 patients with polytetrafluoroethylene hemodialysis grafts who underwent angioplasty of a graft-related stenosis but subsequently required insertion of a stent or stent graft. The study group included 40 patients with >30% residual stenosis and 11 patients with angioplasty-induced venous ruptures. The patient's medical records and radiology reports were reviewed. Patient demographics, indication for stent placement, and the type of stent were recorded. Stent patency was determined using Kaplan-Meier analysis. A total of 70 stents were used; most (57.7%) were deployed across the venous anastomosis. A variety of different types of stents and stent grafts were used including 26 SMART, 18 Viabahn, 13 aSpire, and 13 other stents. The technical success rate for insertion of the device was 100%. Following insertion of the device the primary patency of the vascular access was 81%, 70%, and 54% at 1, 3, and 6 months, respectively. The secondary patency of the vascular access was 89%, 82%, and 74% at 3, 6, and 12 months, respectively. The primary patency of the stent or stent graft was 96%, 93%, 87%, and 47% at 1, 3, 6, and 12 months, respectively. Stents and stent grafts are useful for salvaging failed angioplasty procedures and thereby maintaining patency of the hemodialysis graft. By inserting a stent, the resultant patency rates are similar to those following a successful angioplasty procedure. Importantly, the primary patency of the stent was substantially better than the primary patency of the entire vascular access.