Patency of Wallstents Placed at the Venous Anastomosis of Dialysis Grafts for Salvage of Angioplasty-Induced Rupture

Purpose: To retrospectively evaluate the patency of Wallstents placed at the venous anastomosis of polytetraflouroethylene (PTFE) hemodialysis grafts to preserve function following angioplasty-induced rupture. Methods: The charts of all patients who underwent percutaneous angioplasty of functioning hemodialysis PTFE grafts between September 1997 and September 2001 were retrospectively reviewed. A total of 414 angioplasties were performed. Nine cases of rupture at the venous anastomosis managed with stent placement were identified (7 women, 2 men). Two grafts were loop grafts, seven grafts were straight grafts. All stents placed were Wallstents; six stents were 8 × 40 mm, the remaining three were 8 × 20 mm, 8 × 60 mm and 10 × 42 mm. Average follow-up was 13 months. Results: Technical and clinical success of stent placement was 100%. The primary patency rates (±SE) of stents placed at the venous anastomosis were 88% (12%) at 30 days, 63% (17%) at 90 days, 33% (18%) at 180 days and 17% (15%) at 360 days. The secondary patency rates (±SE) were 89% (11%) at 90 days, 76% (15%) at 180 days and 69% (23%) (6 stents patent) at 360 days. During follow-up, one graft was removed because of infection, one patient died and another was lost to follow-up. A single minor complication of a puncture site hematoma occurred (11%) with no major complications. Conclusions: This small retrospective series suggests that Wallstent placement following angioplasty-induced venous anastomotic rupture is effective for preserving dialyzable flow in hemodialysis grafts. Patency is comparable to that of stents placed for reasons other than rupture.