Complete stent graft relining of the hemodialysis access circuit for access salvage

Abstract

Background: Stent grafts (SGs) are widely used in hemodialysis access procedures to maintain function and patency of the access circuit. There are no reports to date describing complete relining of the access circuit with SGs for extreme access salvage. Objective: To report outcomes and experience with complete SG relining of the hemodialysis access circuit. Methods: From April 2020 to May 2023, all hemodialysis salvage procedures that included complete relining of the access circuit with SGs were retrospectively analyzed from a prospectively collected database of 970 hemodialysis access interventions. SGs were placed for various pathologies including residual stenosis, perforation, aneurysm, and thrombosis. Follow up outcomes included primary patency, primary assisted patency, and secondary patency. Results: A total of 16 patients were included in the study. Average stented length was 30 cm. Average follow up was 283 days (range 38–647 days). The primary patency of the entire covered segment was 80% and 68% at 6 and 12 months, respectively. The primary assisted patency of the segment was 88% and 77% at 6 and 12 months, respectively. Secondary patency of the access circuit was 94% at both 6 and 12 months. There were no issues with SG cannulation and zero cases of SG fracture or infection. Conclusions: Salvage of failing hemodialysis access circuits by complete SG relining should be considered for a limited subgroup of patients where the access circuit would otherwise be deemed unsalvageable. Complete SG relining has both good immediate outcomes and 6- and 12-month patency rates.