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Stent tunnel technique to save thrombosed native hemodialysis fistula with extensive venous aneurysm

Authors Rabellino M, Rosa-Diez GJ, Shinzato SA, Rodriguez P, Peralta OA, Crucelegui MS, Luxardo R, Heredia-Martinez A, Bedini-Rocca MI, García-Mónaco RD

Received 24 March 2017

Accepted for publication 30 June 2017

Published 27 July 2017 Volume 2017:10 Pages 215—219


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Pravin Singhal

Martin Rabellino,1 Guillermo J Rosa-Diez,2 Sergio A Shinzato,1 Pablo Rodriguez,1 Oscar A Peralta,1 Maria S Crucelegui,2 Rosario Luxardo,2 Agustina Heredia-Martinez,2 Mariela I Bedini-Rocca,2 Ricardo D García-Mónaco1

1Department of Angiography and Endovascular Therapy, 2Department of Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Introduction and purpose: The increasing number of patients undergoing hemodialysis and the limited number of access sites have resulted in an increasing number of techniques to maintain vascular access for hemodialysis. Thrombosed arteriovenous (AV) fistulas with large venous aneurysms have poor treatment results, with both endovascular and surgical techniques, leading to a high rate of definitive AV access loss. The purpose of this study was to review the feasibility and initial results of this novel endovascular treatment of thrombosed AV fistulas with large venous aneurysms.
Materials and methods: A novel endovascular treatment technique of inserting nitinol auto-expandable uncovered stents stretching through the whole puncture site area, thus creating a tunnel inside the thrombus, was retrospectively analyzed and described.
Results: A total of 17 stents were placed in 10 hemodialysis fistulas, with a mean venous coverage length of 17.8 cm. In all the cases, 100% technical success was achieved, with complete restoration of blood flow in all patients. There were no procedure-related complications. The mean follow-up was 167 days (range 60–420 days), with a primary and assisted patency of 80% and 100%, respectively. No multiple trans-stent struts-related complications were observed. Three stent fractures were diagnosed with plain films at the site of puncture without consequence in the venous access permeability.
Conclusion: The “stent tunnel technique” is a feasible, safe and effective alternative to salvage native hemodialysis access, thus extending the function of the venous access with no signs of stent-related complications and a respectable midterm patency.

Keywords: vascular access, hemodialysis, endovascular procedure, thrombosed native hemodialysis, aneurysm, stent, stent tunnel technique

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