Covered stent exclusion of dialysis access pseudoaneurysms

J Surg Res. 2002 Jul;106(1):15-9. doi: 10.1006/jsre.2002.6389.

Abstract

Background: The traditional repair of hemodialysis graft pseudoaneurysms has been to surgically replace that segment of involved PTFE graft material or autogenous vein. We report a novel approach to these lesions, employing a covered stent (Wallgraft) for exclusion of arteriovenous graft (AVG) and arteriovenous fistula (AVF) pseudoaneurysms.

Methods: Ten patients with AVG or AVF pseudoaneurysms were treated endoluminally by covered stent exclusion. Wallgraft implantations were performed in the operating room with interventional capabilities under local anesthesia through a percutaneous access. Follow-up included physical examination at 2 weeks and duplex ultrasound of AVG/ AVF at 6 months after surgery.

Results: Ten patients with pseudoaneurysmal degeneration of their AVG/AVF were identified. The mean diameter of the pseudoaneurysmal segment was 3 cm (range, 1.5-5 cm). Immediately following covered stent implantation all the patients had palpable pulses in the pseudoaneurysms despite adequate coverage by angiography. At the 2-week follow-up visit all had lost the palpable pseudoaneurysm pulsation while the AVGs remained functional in nine patients. One patient had early thrombosis of the AVG. The follow-up duplex scans at 6 months showed complete exclusion of the pseudoaneurysms in seven patients. Two patients had thrombosis of their dialysis access, at 3 weeks (n = 1) and 3 months (n = 1) post-implantation.

Conclusion: Endovascular covered stent exclusion of AV dialysis access pseudoaneurysms is safe and technically feasible in eliminating flow through dialysis access pseudoaneurysms and represents a novel and simple approach to this common problem, prolonging the functional life of the access site.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / surgery*
  • Arteriovenous Shunt, Surgical*
  • Blood Vessel Prosthesis Implantation*
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Polytetrafluoroethylene / therapeutic use
  • Renal Dialysis
  • Stents*
  • Ultrasonography

Substances

  • Polytetrafluoroethylene