The role of the endoluminal stent in the management of venous stenosis of dialysis access is unclear. Although stents can help manage some access difficulties, they are sometimes inappropriately utilized. Stents are not permanent solutions. With the exception of the Flair™ Endovascular Stent Graft (C. R. Bard, Inc.; Tempe, AZ), they are not FDA approved for dialysis vascular access use. In addition, they add significant cost and a new set of possible complications.
The clinician should therefore be very selective in the use of stents for the treatment of stenotic dialysis access. Stent placement is justified only when its use will clearly result in one or more of the following benefits:
- Extends access life
- Saves an otherwise failed access
- Avoids surgery
Although a stent can improve the appearance of a lesion, it is unclear if these devices provide benefits and long-term outcomes that justify their increased cost and potential complications. Angioplasty alone should therefore be used as the primary treatment modality for all venous lesions. (See "Percutaneous angioplasty for the treatment of venous stenosis affecting hemodialysis access grafts".)
Primary patency rates following the venous use of stents have been relatively poor, being approximately 20 percent at one year [1-3]. However, with aggressive reintervention, the cumulative patency rate is approximately 70 percent at one year.