Stent Grafts Across the Elbow Joint for Access Salvage

Abstract

Purpose:

Covered stent grafts (SGs) are currently being used in a wide variety of situations to maintain function and patency of hemodialysis access circuits. Stent grafts are rarely placed across the elbow joint (EJ), however, due to fear of stent fracture. This study reports on the experience and patency rates with SGs across the EJ.

Materials and Methods:

From April 2020 to August 2023, all procedures with SGs placed across the EJ were retrospectively analyzed. A total of 21 patients with SGs placed across the EJ were included in the study. The Covera Vascular Covered Stent (BD, Franklin Lakes, New Jersey, USA) was used in all cases. Of these, 18 were arteriovenous (AV) fistulae, and 3 were AV grafts. Stent grafts were placed for various pathologies, including residual stenosis, perforation, aneurysm, and thrombosis. Follow-up outcomes were obtained from angiographic images on follow-up angiography and included primary patency, primary assisted patency, and secondary patency.

Results:

The primary patency of the target lesion was 85% (CI=70%–100%) and 85% (CI=70%–100%) at 6 and 12 months, respectively. The primary assisted patency was 85% (CI=70%–100%) and 85% (CI=70%–100%) at 6 and 12 months, respectively. Secondary patency of the access circuit was 95% (CI=86%–100%) at 6 months and 89% (CI=75%–100%) at 12 months. The average follow-up duration was 393 days (range=27–768 days). There were no instances of stent fracture during follow-up.

Conclusions:

Stent grafts should be placed across the EJ for good short-term and mid-term patency rates.

Clinical Impact

The placement of stent grafts across the elbow joint in hemodialysis patients for access salvage is controversial due to the fear of stent fracture or occlusion. This retrospective study evaluated the placement of stent grafts for access salvage in 21 patients for various etiologies. Good patency rates were seen out to 12 months and no stent fractures were observed. Although longer term data is needed, stent grafts should be considered an acceptable option for access salvage when treating lesions that cross the elbow joint.