Shuji Kariya MD, Presenter: Nothing to Disclose

Noboru Tanigawa MD,PHD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Kojima MD, Abstract Co-Author: Nothing to Disclose

Atsushi Komemushi MD, PhD, Abstract Co-Author: Nothing to Disclose

Yuzo Shomura MD, Abstract Co-Author: Nothing to Disclose

Tomokuni Shiraishi MD, Abstract Co-Author: Nothing to Disclose

Toshiaki Kawanaka MD,PHD, Abstract Co-Author: Nothing to Disclose

Satoshi Sawada MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the effectiveness of stent placement for hemodialysis access stenosis of resistance to balloon angioplasty by comparing with only balloon angioplasty.

Of 250 patients with 391 hemodialysis access stenoses performed percutaneous transluminal angioplasty, non-covered self-expandable stents were placed in 48 patients with 48 stenoses from August 2000 to January 2006. Stent placement followed balloon dilatation and was performed if the result of that balloon dilatation was considered low access flow for hemodialysis due to insufficient dilatation, or that balloon dilatation for the restenosis caused within three months after the last balloon angioplasty was able to obtain only the same vascular diameter as the previous that. An insufficient dilatation was defined as the residual stenosis of 50% or more, or as the stenosis due to vascular injury caused by balloon angioplasty. The patency rates were calculated by Kaplan-Meier method and Logrank test.

Clinical success rate of stent placement was 95.8% (46 of 48). Residual percent diameter stenosis in 48 stenoses was 54.3±18.6% after only balloon angioplasty, and was 19.9±14.4% after stent placement. In 46 stenoses after stent placement, 6, 12, 24 and 36-month primary patency rates were 65.4%, 34.0%, 21.6% and 16.2%. In 46 patients after stent placements, 36-month secondary patency rates were 88.7%, however multiple repeat balloon angioplasty were required. In 46 stenoses, the primary patency rates were significantly lower than 329 stenoses performed only balloon angioplasty (p=0.012). Of 46 stenoses in 28 stenoses with the history of only balloon angioplasty for the same lesion in the past, the patency rates after stent placements were significantly higher than that after only balloon angioplasty (p <0.001).

Stent placement for stenosis of resistance to balloon angioplasty is effective for clinical success and patency rate, however the patency rate is lower than that of angioplasty that is not resistance to balloon dilatation, and multiple repeat balloon angioplasty were frequently required to maintain patency.

Stent placement for stenosis of resistance to balloon angioplasty is recommended.

Kariya, S, Tanigawa, N, Kojima, H, Komemushi, A, Shomura, Y, Shiraishi, T, Kawanaka, T, Sawada, S, et al, , Stent Placement for Hemodialysis Access Stenosis of Resistance to Balloon Angioplasty: Comparison with Only Balloon Angioplasty.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4440798.html