Louise Moist, MD, MSc
In patients treated with hemodialysis, are stent grafts more effective than angioplasty alone for revision of venous anastomotic stenosis in failing arteriovenous (AV) access grafts?
Randomized controlled trial. ClinicalTrials.gov NCT00678249.
13 interventional radiology or vascular surgery sites in the USA.
190 patients 18 to 90 years of age (mean age 61 y, 64% women) who had end-stage renal disease requiring long-term hemodialysis; ≥ 50% stenosis within 7 cm of the venous anastomosis in a synthetic AV access graft in the arm; and abnormalities (as defined by the Kidney Disease Outcomes Quality Initiative guidelines) in clinical access status, access flow monitoring, or static venous pressure monitoring.
After successful balloon angioplasty, patients had placement of ≥ 1 expanded polytetrafluoroethylene (PTFE) stent grafts (n = 97) or no further treatment (n = 93).
Primary patency in the treatment area (absence of reintervention or thrombotic occlusion in the treatment area, surgical intervention excluding the treatment area from the access circuit, and abandonment of the AV access graft), primary patency of the access circuit (absence of occlusion or intervention for stenosis anywhere within the access circuit and surgical intervention excluding the index stenotic area from the access circuit), freedom from subsequent intervention, restenosis > 50%, and success rates.
94% (intention-to-treat analysis).
At 6 months, primary patency was more likely in the stent-graft group (Table). Patients in the stent-graft group were less likely to require subsequent interventions or have restenosis > 50% (Table). Groups did not differ for hemodynamic success (resolution of the clinical problem, access flow, or venous pressure abnormality; 100% in each group) or clinical success (≥ 1 normal dialysis session; 88% vs 84%). Anatomical success (reduction of the lesion to < 30%) and procedural success (anatomical success plus ≥ 1 indicator of hemodynamic or clinical success) were both achieved in 94% of the stent-graft group and 73% of the control group (P < 0.001).
In patients treated with hemodialysis, stent grafts were more effective than angioplasty alone for revision of venous anastomotic stenosis in failing arteriovenous access grafts.
Stent graft vs balloon angioplasty alone (control) for revision of venous anastomotic stenosis in failing arteriovenous dialysis-access grafts†
†Abbreviations defined in Glossary. RBI, RRR, NNT, and CI calculated from data in article.
Moist L. Stent grafts were more effective than balloon angioplasty alone for revision of stenosis in failing dialysis-access grafts. Ann Intern Med. 2010;152:JC6–8. doi: 10.7326/0003-4819-152-12-201006150-02008
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Published: Ann Intern Med. 2010;152(12):JC6-8.
Nephrology, Renal Replacement Therapy.
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