Stent Graft deployment for AV Graft salvage

Despite the growing prevalence of end stage renal disease, AV Graft/ Fistula salvage procedures are still understudied. In this case a stent graft was used to treat an In-Stent-Restenosis of the innominate vein.


    Dr. Theodosios Bisdas
    May 26, 2018

    Excellent case Kostas! Thank you for this. I have two questions for you:
    1. Which is your treatment strategy for central vein stenosis: DCB, BMS or stent-graft. If you use BMS, which one do you recommend?
    2. What is the role of DAART for such ISR in AV-fistula?

    Thank you Theo for your comment!
    1) Given the lack of head to head comparisons/trials only an individualized approach can be recommended. Despite the lack of data we usually try to avoid a stent deployment and we favor DCB angioplasty. The launch of DCBs up to 12mm might be useful in the treatment of central vein stenosis. On the other hand, fibrotic lesions might require a stent. A strategy that could be valuable is the use of vein dedicated stents, as the one used for the pelvic veins. Of note this strategy is not in the IFUs of these devices and we have no data at all.

    2) The problem of the most vessel prep modalities is that they are all designed for the peripheral vasculature (lower extremities). Thus, they are sufficient in the treatment of vessels with a max. diameter of 7-8 mm. In this context, their use in central veins is up to now not really reasonable.
    However, they might provide a benefit in the treatment of AV-Fistula stenosis of the upper extremities. Again, this is only hypothetical as no study evaluated the efficacy of DAART for AV-Fistula/graft salvage.

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