Salvage of angioplasty failures and complications in hemodialysis arteriovenous access using the FLUENCY plus stent graft: Technical and 180-day patency results

Purpose: To review technical and 180-day clinical outcomes when stent grafts were used to treat dysfunctional arteriovenous (AV) hemodialysis access circuits. Materials and Methods: The FLUENCY Plus Stent Graft (Bard Peripheral Vascular, Tempe, Arizona) was used to salvage percutaneous transluminal angioplasty (PTA) technical failures and complications in AV access circuits over 2 years. There were 106 patients treated with 138 stent grafts. Indications for stent graft use included residual stenosis after PTA (n = 81), extravasation after PTA (n = 22), early recurrent stenosis (n = 14), pseudoaneurysms (n = 4), and "other" (n = 4). Data were retrospectively analyzed for complications and outcomes. Results: Technical success was achieved in all patients, and clinical success was achieved in 104 (98%) of 106 patients. At 180 days, postintervention primary patency (PIPP) was 47%, and postintervention secondary patency (PISP) was 79%. PIPP was 62% for autogenous fistulas (AVFs) and 35% for prosthetic grafts (AVGs) (P =.010). The 180-day PIPP for stent grafts 910 mm in diameter was 63% versus 38% for stent grafts 68 mm in diameter (P =.012). Implants that did not cross the elbow had a 180-day PIPP of 47% compared with 25% for implants across the elbow (P =.032). Technical complications were periprocedure AVG thromboses (n = 2), intraprocedural stent graft dislodgment (n = 1), venospasm (n = 2), and contrast agentrelated hives (n = 1). One patient returned at 2 months with an infected AVG and stent graft in the outflow vein. Conclusions: The FLUENCY Plus Stent Graft was effective for maintenance of hemodialysis access circuit patency and was comparable or better than historical outcomes for PTA and bare stents. Factors that favored improved patency included larger diameter devices, use in AVFs, and avoiding placement across the elbow joint.