A novel surgical approach for edge collapse of a covered stent in hemodialysis access: Case report and follow-up

Abstract

The use of covered stents in hemodialysis vascular access has increased in recent years. The most frequently reported mode of stent failure is edge restenosis, whereas edge collapse is extremely rare and has seldom been described. We report the case of a 48-year-old man who initially underwent placement of a covered stent in the cephalic arch, followed 1 year later by deployment of a second stent for edge stenosis. Two months thereafter, collapse of the distal edge of the second stent resulted in thrombosis of the arteriovenous fistula. Although surgical thrombectomy combined with percutaneous transluminal angioplasty (PTA) temporarily restored the stent configuration, recurrent collapse was observed 2 days later. To address this, a limited skin incision was made near the distal edge of the stent, and under ultrasound guidance, the collapsed edge was sutured and fixed to the surrounding subcutaneous tissue to prevent further infolding. This approach achieved durable results, with follow-up examinations at 2 and 6 months showing no recurrence of collapse, preserved stent patency, and stable fistula function with reduced tension. This case highlights the potential role and effectiveness of surgical fixation in managing the rare complication of stent edge collapse in hemodialysis access.