Use of stents for venous stenosis associated with dialysis vascular access
- Gerald A Beathard, MD, PhD
Gerald A Beathard, MD, PhD
- Clinical Professor
- University of Texas Medical Branch
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
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- Recurrent peripheral lesions
- Elastic lesions
- Vein rupture
- Newer possible indications
- - Extrinsic compression of the left innominate vein
- - Pseudoaneurysm formation
- DIFFERENT STENTS
- Balloon expandable stent
- Self-expanding stents
- - Stainless steel stents
- - Nitinol stents
- Stent grafts
- Drug-eluting stents
- Access patency with different stents
- Choice of stent
- Neointimal hyperplasia
- Vein depletion
- Inaccessibility for cannulation
- Stent migration
- SUMMARY AND RECOMMENDATIONS