PMID- 35098757 OWN - NLM STAT- MEDLINE DCOM- 20230328 LR - 20230403 IS - 1545-1550 (Electronic) IS - 1526-6028 (Linking) VI - 30 IP - 2 DP - 2023 Apr TI - Long-term Results of Interwoven Nitinol Stents to Treat the Radiocephalic Anastomotic Arteriovenous Fistula Stenosis. PG - 176-184 LID - 10.1177/15266028221075230 [doi] AB - INTRODUCTION: Juxta-anastomotic stenosis (JXAS) is a common problem afflicting the arteriovenous fistula (AVF). This study aimed to evaluate the safety and long-term efficacy of an interwoven nitinol stent (Supera, Abbott Vascular, Santa Clara, CA, USA) in the treatment of radiocephalic AVF JXAS. METHODS: A single-center, retrospective, observational study was conducted of patients with failing AVF due to JXAS treated with an interwoven nitinol stent. End points included JXAS target lesion primary patency, access circuit primary patency, assisted access circuit primary patency, and endovascular intervention rate (EIR). RESULTS: Sixty patients were treated with a Supera stent in the JXAS between February 2014 and March 2020. One patient was excluded (AVF used for illicit drug use), leaving 59 patients (67.8% male, mean age 66.9 +/- 11.4 years [range: 40-84]) with typical medical comorbidities. Overall, 45.8% of patients had previous AVF intervention. The stent was inserted with a 100% technical success rate with a mean follow-up of 729.6 +/- 456.0 days (range: 5-2182 days). Juxta-anastomotic stenosis target lesion primary patency was 68.2 +/- 6.6%, 53.3 +/- 7.5%, and 46.2 +/- 8.1% at 12, 24, and 36 months, respectively. The EIR was .64 (0-3.29) procedures/patient/year, after which the assisted access circuit primary patency rate was 94.3 +/- 3.2% at 12, 24, and 36 month time points. Three thrombosed circuits occurred which were all successfully salvaged with no difference in patency by indication for procedure and no AVFs lost/abandoned out to 3 years. Avoidance of stent post-dilatation and the presence of stent mal-apposition were associated with improved primary patency, and reduced EIR, which may suggest an importance in vessel preparation prior to stent implantation. CONCLUSION: Interwoven nitinol stent treatment of the failing AVF with JXAS results in promising 3 year JXAS patency, with a low rate of endovascular re-intervention for those circuits developing restenosis. All AVFs were maintained over 3 years, demonstrating this treatment allows for long-term radiocephalic AVF vascular access. FAU - Thomas, Shannon D AU - Thomas SD AUID- ORCID: 0000-0001-8717-4406 AD - Department of Vascular Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia. AD - Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia. AD - The Vascular Institute, Prince of Wales Private Hospital, Sydney, NSW, Australia. FAU - Peden, Samantha AU - Peden S AD - Department of Vascular Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia. FAU - Katib, Nedal AU - Katib N AD - Department of Vascular Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia. AD - Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia. AD - The Vascular Institute, Prince of Wales Private Hospital, Sydney, NSW, Australia. FAU - Crowe, Phillip AU - Crowe P AD - Department of Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia. FAU - Barber, Tracie AU - Barber T AUID- ORCID: 0000-0002-6574-8074 AD - Faculty of Mechanical Engineering, UNSW Sydney, Sydney, NSW, Australia. FAU - Varcoe, Ramon L AU - Varcoe RL AUID- ORCID: 0000-0001-5611-6991 AD - Department of Vascular Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia. AD - Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia. AD - The Vascular Institute, Prince of Wales Private Hospital, Sydney, NSW, Australia. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20220131 PL - United States TA - J Endovasc Ther JT - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists JID - 100896915 RN - 2EWL73IJ7F (nitinol) SB - IM MH - Humans MH - Male MH - Middle Aged MH - Aged MH - Female MH - *Arteriovenous Shunt, Surgical/adverse effects MH - Graft Occlusion, Vascular/diagnostic imaging/etiology/therapy MH - Vascular Patency MH - Retrospective Studies MH - Constriction, Pathologic MH - Renal Dialysis MH - *Angioplasty, Balloon/adverse effects MH - Treatment Outcome MH - Stents MH - *Arteriovenous Fistula/etiology OTO - NOTNLM OT - anastomosis OT - arteriovenous fistula OT - dialysis OT - endovascular treatment/therapy OT - stent * OT - vascular access EDAT- 2022/02/01 06:00 MHDA- 2023/03/28 16:47 CRDT- 2022/01/31 08:42 PHST- 2023/03/28 16:47 [medline] PHST- 2022/02/01 06:00 [pubmed] PHST- 2022/01/31 08:42 [entrez] AID - 10.1177/15266028221075230 [doi] PST - ppublish SO - J Endovasc Ther. 2023 Apr;30(2):176-184. doi: 10.1177/15266028221075230. Epub 2022 Jan 31.