The Role of Covered Stents in Hemodialysis Access: Experience From a Vascular Access Centre

TL;DR

This study examines how covered stents affect vascular access in hemodialysis patients, finding they delay but do not prevent the need for further interventions.

Contribution

The study provides real-world evidence on the effectiveness of covered stents in hemodialysis vascular access.

Findings

Covered stents did not reduce the number of interventions but extended the time until reintervention.

Primary patency was significantly higher in arteriovenous fistulas compared to arteriovenous grafts.

Careful patient selection is crucial for optimal use of covered stents in hemodialysis.

Abstract

Background

Vascular access (VA) dysfunction in hemodialysis (HD) significantly impacts patient outcomes. While percutaneous transluminal angioplasty remains the primary intervention, covered stents (CSs) have emerged as a valuable adjunct. This study evaluates the efficacy of CS in reducing reinterventions and delaying subsequent procedures.

Methods

This retrospective study included patients who underwent their first CS placement at the SANFIL Vascular Access Centre between 2017 and 2022, involving arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). The primary outcome was a comparison of the number of procedures 12 months before and after CS placement. Secondary outcomes assessed primary patency (PP), assisted primary patency (APP), secondary patency (SP), and factors influencing these outcomes.

Results

Eleven patients were included, 72.7% male, with a mean age of 74.6 ± 8.8 years. Seven (63.6%) patients had an AVF. In the 12 months after CS placement, only two VAs did not require reintervention, while the remaining nine exhibited CS-related dysfunctions. The mean number of interventions in the 12 months before and after CS placement was similar (1.73 ± 1.01 and 1.64 ± 1.63, respectively; p = 0.85). However, the mean time to reintervention after CS placement was longer than the previous intervention: 6.22 ± 3.67 and 2.63 ± 2.60 months, respectively. PP was significantly higher in AVFs than in AVGs.

Conclusions

CS placement may delay the need for subsequent interventions, but it does not significantly reduce the frequency of procedures or improve overall VA survival. The decision to deploy a CS should be made on a case-by-case basis, particularly for patients with limited vascular options or those who are unable to undergo additional surgical procedures. Careful patient selection is essential to ensure the optimal use of CS in HD patients.

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