Drug-Eluting Stent for the Treatment of Early Fistula Failure
Author(s)
Luigi Di Serafino,
Laura Scudiero,
Mario De Laurentis,
Federica Ilardi,
Fabio Magliulo,
Giuseppe Carotenuto,
Cinzia Perrino,
Giovanni Esposito
ABSTRACT
Introduction: Morbidity and mortality in chronic haemodialysis patients is related to dialysis efficiency. Several complications may occur with vascular access, usually associated with a stenosis. This is known to occur frequently in the venous outflow. Stenosis of the arterial side is not as frequently discussed, but it is also likely to compromise fistula function. Traditionally, surgical and percutaneous interventions have been used to treat failing fistulas, but the employment of drug-eluting stents for the treatment of failing fistulas due to the arterial stenosis has been described rarely. Methods: A 65-year-old male patient referred to our ambulatory because of hand ischemia during haemodialysis treatments only few days after radial-cephalic fistula creation. After physical and echo-color-doppler examination, angiography was performed and percutaneous intervention was proposed. After the positioning of a guiding catheter, the lesion was crossed with a 0.014” guide wire followed by direct drug-eluting stent implantation. Results: Final angiogram showed a good result and a preserved flow through the fistula. Six months later the patient was asymptomatic and the fistula was still working. Conclusion: Although further prospective studies are necessary, percutaneous transluminal angioplasty (PTA) with drug-eluting stents implantation could be considered a safe and effective technique for the treatment of arteriovenous fistulas stenosis.
Introduction: Morbidity and mortality in chronic haemodialysis patients is related to dialysis efficiency. Several complications may occur with vascular access, usually associated with a stenosis. This is known to occur frequently in the venous outflow. Stenosis of the arterial side is not as frequently discussed, but it is also likely to compromise fistula function. Traditionally, surgical and percutaneous interventions have been used to treat failing fistulas, but the employment of drug-eluting stents for the treatment of failing fistulas due to the arterial stenosis has been described rarely. Methods: A 65-year-old male patient referred to our ambulatory because of hand ischemia during haemodialysis treatments only few days after radial-cephalic fistula creation. After physical and echo-color-doppler examination, angiography was performed and percutaneous intervention was proposed. After the positioning of a guiding catheter, the lesion was crossed with a 0.014” guide wire followed by direct drug-eluting stent implantation. Results: Final angiogram showed a good result and a preserved flow through the fistula. Six months later the patient was asymptomatic and the fistula was still working. Conclusion: Although further prospective studies are necessary, percutaneous transluminal angioplasty (PTA) with drug-eluting stents implantation could be considered a safe and effective technique for the treatment of arteriovenous fistulas stenosis.
KEYWORDS
Arteriovenous Fistula, Percutaneous Transluminal Angioplasty, Haemodialysis, Drug-Eluting Stents
Arteriovenous Fistula, Percutaneous Transluminal Angioplasty, Haemodialysis, Drug-Eluting Stents
Cite this paper
nullL. Serafino, L. Scudiero, M. Laurentis, F. Ilardi, F. Magliulo, G. Carotenuto, C. Perrino and G. Esposito, "Drug-Eluting Stent for the Treatment of Early Fistula Failure," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 196-200. doi: 10.4236/ijcm.2011.23032.
nullL. Serafino, L. Scudiero, M. Laurentis, F. Ilardi, F. Magliulo, G. Carotenuto, C. Perrino and G. Esposito, "Drug-Eluting Stent for the Treatment of Early Fistula Failure," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 196-200. doi: 10.4236/ijcm.2011.23032.
References
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[1] K. R. Polkinghorne, S. P. McDonald, R. C. Atkins and P. G. Kerr, “Vascular access and all-cause mortality: a propensity score analysis,” J Am Soc Nephrol, Vol. 15, No. 2, 2004, pp. 477-486. [2] C. L. Bent, D. K. Rajan, K. Tan, et al., “Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas,” J Vasc Interv Radiol, Vol. 21, No. 4, April 2010, pp. 496-502. [3] G. A. Beathard, “Angioplasty for arteriovenous grafts and fistulae,” Semin Nephrol, Vol. 22, No. 3, 2002, pp. 202- 210. [4] G. A. Beathard, S. M. Settle and M. W. Shields, “Salvage of the nonfunctioning arteriovenous fistula,” Am J Kidney Dis, Vol. 33, No. 5, May 1999, pp. 910-916. [5] L. Turmel-Rodrigues, A. Mouton, B. Birmele, et al., “Salvage of immature forearm fistulas for haemodialysis by interventional radiology,” Nephrol Dial Transplant, Vol. 16, No. 12, December 2001, pp. 2365-2371. [6] D. G. Miquelin, L. F. Reis, A. A. da Silva and J. M. de Godoy, “Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis,” Int Arch Med, Vol. 1, No. 1, September 2008, pp.16. [7] M. R. Chan, S. Bedi, R. J. Sanchez, et al., “Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistulae,” Clin J Am Soc Nephrol, Vol. 3, No. 3, May 2008, pp. 699-705. [8] S. Ohira, H. Naito, I. Amano, et al., “2005 Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis,” Ther Apher Dial, Vol. 10, No. 5, 2006, pp. 449-462. [9] J. M. Weiswasser, D. Kellicut, S. Arora and A. N. Sidawy, “Strategies of arteriovenous dialysis access,” Semin Vasc Surg, Vol. 17, No. 1, 2004, pp. 10-18. [10] A. Asif, P. Roy-Chaudhury and G. A. Beathard, “Early arteriovenous fistula failure: a logical proposal for when and how to intervene,” Clin J Am Soc Nephrol, Vol. 1, No. 2, 2006, pp. 332-339. [11] S. T. Patel, J. Hughes and J. L. Mills Sr, “Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access,” J Vasc Surg, Vol. 38, No. 3, September 2003, pp. 439-445; discussion 445. [12] S. S. Berman and A. T. Gentile, “Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance,” J Vasc Surg, Vol. 34, No. 5, November 2001, pp. 866-871. [13] L. M. Dember, G. J. Beck, M. Allon, et al., “Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial,” Jama, Vol. 299, No. 18, May 2008, pp.16. 2164-2171. [14] M. Haimov, H. Schanzer and M. Skladani, “Pathogenesis and management of upper-extremity ischemia following angioaccess surgery,” Blood Purif, Vol. 14, No. 5, 1996, pp. 350-354. [15] J. C. West, D. J. Bertsch, S. L. Peterson, et al., “Arterial insufficiency in hemodialysis access procedures: correction by “banding” technique,” Transplant Proc, Vol. 23, No. 2, 1991, pp. 1838-1840. [16] A. B. Redfern and N. B. Zimmerman, “Neurologic and ischemic complications of upper extremity vascular access for dialysis,” J Hand Surg Am, Vol. 20, No. 2, March 1995, pp. 199-204. [17] A. Guerra, A. Raynaud, B. Beyssen, J. Y. Pagny, M. Sapoval and C. Angel, “Arterial percutaneous angioplasty in upper limbs with vascular access devices for haemodialysis,” Nephrol Dial Transplant, Vol. 17, No. 5, 2002, pp. 843-851. [18] H. I. Manninen, E. Kaukanen, K. Makinen and P. Karhapaa, “Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas,” J Vasc Interv Radiol, Vol. 19, No. 6, June 2008, pp. 870-876. [19] I. T. Meredith, S. Worthley, R. Whitbourn, et al., “Clinical and angiographic results with the next-generation resolute stent system: a prospective, multicenter, first- in-human trial,” JACC Cardiovasc Interv, Vol. 2, No. 10, Oct 2009, pp. 977-985.