Small Oversized Stent Graft Is Associated With Increased Patency for the Treatment of Central Venous Disease in Hemodialysis Patients

Abstract

Purpose:

The purpose of this study was to identify the independent predictors of higher patency rates and investigate the selection of specifications of stent graft in the treatment of central venous disease.

Materials and Methods:

This retrospective study included 54 patients who underwent stent–grafts’ placement for the treatment of central venous disease between March 2017 and September 2022 at a tertiary hospital. The demographic data for the patients and the clinical data of the treated lesions were collected and analyzed. The patency rates of the treated lesions with different oversizing range were calculated via the Kaplan-Meier and log-rank analyses. The multivariate Cox proportional hazard models were constructed to identify the independent predictor of the target site primary patency.

Results:

The median follow-up period was 21.5 months. The primary patency rates of the target sites were 90.7%, 72.2%, and 55.1% at 6, 12, and 24 months, respectively. The assisted primary patency rates of the lesions were 96.3%, 92.5%, and 80.3% at 6, 12, and 24 months, respectively. The log-rank analysis showed that the stent–grafts’ placement with small oversizing had significantly higher primary patency rates than those with large oversizing (p=0.022). The multivariate analysis revealed that concomitant stenosis and large oversizing stent graft were the independent predictors of target site primary patency.

Conclusions:

Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing.

Clinical Impact

Stent grafts showed reasonable primary patency for the treatment of central venous disease in hemodialysis patients. Few studies, however, have explored the efficiency of stent grafts to treat CVD by considering different factors such as sizing considerations, the rate of oversizing percentage, etc. A stent graft with small oversizing is associated with better target site primary patency rates than those with large oversizing. Excessive oversizing should be avoided to prevent infolding or stent collapse.

Keywords

central venous disease stent graft oversize patency hemodialysis

Get full access to this article

View all access options for this article.

References

Kundu

Review of central venous disease in hemodialysis patients. J Vasc Interv Radiol. 2010;21(7):963–968. doi:10.1016/j.jvir.2010.01.044.

Chen

Lin

CH.

Outcomes of the Gore Excluder abdominal aortic aneurysm leg endoprosthesis for treatment of central vein stenosis or occlusion in patients with chronic hemodialysis. J Vasc Surg Venous Lymphat Disord. 2020;8(2):195–204. doi:10.1016/j.jvsv.2019.08.017.

Agarwal

Haddad

Khabiri

How should symptomatic central vein stenosis be managed in hemodialysis patients?

Semin Dial. 2014;27(3):278–281. doi:10.1111/sdi.12205.

Lok

Huber

Lee

, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4 suppl 2):S1–S164. doi:10.1053/j.ajkd.2019.12.001.

Kundu

Modabber

You

, et al. Use of PTFE stent grafts for hemodialysis-related central venous occlusions: intermediate-term results. Cardiovasc Intervent Radiol. 2011;34(5):949–957. doi:10.1007/s00270-010-0019-4.

Rasmussen

Feldman

Beathard

, et al. Indications for stent placement in a dialysis access. Semin Dial. 2008;21(1):83–84. doi:10.1111/j.1525-139X.2007.00377.x.

Chen

, et al. Comparison of percutaneous transluminal angioplasty with stenting for treatment of central venous stenosis or occlusion in hemodialysis patients: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2020;43(4):525–540. doi:10.1007/s00270-019-02383-7.

Chen

Lai

Fedally

, et al. Migration of covered stents in thoracic central vein obstruction procedures in patients with hemodialysis: case report and literature review. Front Cardiovasc Med. 2022;9:954443. doi:10.3389/fcvm.2022.954443.

Lee

Mokrzycki

Moist

, et al. Standardized definitions for hemodialysis vascular access. Semin Dial. 2011;24(5):515–524. doi:10.1111/j.1525-139X.2011.00969.x.

10.

Sacks

McClenny

Cardella

, et al. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9, pt 2):S199–S202. doi:10.1097/01.rvi.0000094584.83406.3e.

11.

Kitahara

Okada

Kimura

, et al. Impact of stent size selection on acute and long-term outcomes after drug-eluting stent implantation in de novo coronary lesions. Circ Cardiovasc Interv. 2017;10(10):e004795. doi:10.1161/CIRCINTERVENTIONS.116.004795.

12.

Agarwal

Patel

Haddad

NJ.

Central vein stenosis: a nephrologist’s perspective. Semin Dial. 2007;20(1):53–62. doi:10.1111/j.1525-139X.2007.00242.x.

13.

Chen

Lin

Dai

, et al. One-year outcomes and predictive factors for primary patency after stent placement for treatment of central venous occlusive disease in hemodialysis patients. Ther Adv Chronic Dis. 2022;13:20406223211063039. doi:10.1177/20406223211063039.

14.

III.NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(1 suppl 1):S137–S181. doi:10.1016/s0272-6386(01)70007-8.

15.

Haskal

Trerotola

Dolmatch

, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010;362(6):494–503. doi:10.1056/NEJMoa0902045.

16.

Anaya-Ayala

Smolock

Colvard

, et al. Efficacy of covered stent placement for central venous occlusive disease in hemodialysis patients. J Vasc Surg. 2011;54(3):754–759. doi:10.1016/j.jvs.2011.03.260.

17.

Quaretti

Galli

Moramarco

, et al. Stent grafts provided superior primary patency for central venous stenosis treatment in comparison with angioplasty and bare metal stent: a retrospective single center study on 70 hemodialysis patients. Vasc Endovascular Surg. 2016;50(4):221–230. doi:10.1177/1538574416639149.

18.

Shemesh

Goldin

Zaghal

, et al. Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg. 2008;48(6):1524–1531. doi:10.1016/j.jvs.2008.07.071.

19.

Jones

Willis

Jones

, et al. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol. 2011;22(9):1240–1245. doi:10.1016/j.jvir.2011.06.002.

20.

Entwisle

Watkinson

Reidy

Case report: migration and shortening of a self-expanding metallic stent complicating the treatment of malignant superior vena cava stenosis. Clin Radiol. 1996;51(8):593–595. doi:10.1016/s0009-9260(96)80144-9.

21.

Dougherty

MJ.

Routine use of large-diameter stent grafts for hemodialysis-related central venous obstruction. J Vasc Surg Venous Lymphat Disord. 2020;8(2):205–206. doi:10.1016/j.jvsv.2019.09.005.

22.

Taylor

Lehmann

Belli

, et al. Strategies for the management of SVC stent migration into the right atrium. Cardiovasc Intervent Radiol. 2007;30(5):1003–1009. doi:10.1007/s00270-007-9109-3.

23.

Chiang

Yeh

Chen

, et al. Apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. Ann Vasc Surg. 2016;31:196–204. doi:10.1016/j.avsg.2015.10.007.

24.

Dashkoff

Blessios

Cox

MR.

Migration of covered stents from hemodialysis A-V access to the pulmonary artery: percutaneous stent retrieval and procedural trends. Catheter Cardiovasc Interv. 2010;76(4):595–601. doi:10.1002/ccd.22553.