Document Detail


Stent graft treatment for hemodialysis access aneurysms.
MedLine Citation:
PMID:  21658886     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aneurysms that develop in arteriovenous accesses as a result of repeated punctures are sometimes complicated by infection or ischemia causing sloughing of the overlying skin, which may endanger the access and risk major bleeding and other complications. Surgical revision may necessitate the temporary use of a central venous catheter until dialysis can be resumed via the access. We used stent grafts in selected patients for the exclusion of access aneurysms.
METHODS: Twenty of 63 patients requiring access revision for complication of an aneurysm from February 2005 to December 2009 underwent ambulatory endovascular stent graft deployment. Indications included signs of impending rupture, questionable viability of overlying skin, pain, infection, and limitation of cannulation sites by the size or number of the aneurysms. Endovascular treatment always included angioplasty of associated outflow or central vein stenoses at the same ambulatory session.
RESULTS: Twenty patients with complicated access aneurysms were treated by endovascular stent graft exclusion at an average of 4.8 ± 4.3 years (range, 0.2 to 16.1 years) after access construction: nine graft pseudoaneurysms, nine native vein aneurysms, and two acute iatrogenic pseudoaneurysms. Six patients had skin erosion over the aneurysm, and 12 had painful aneurysms and clinical signs of compromised blood supply to the skin. Another two patients with an acute giant false aneurysm occurring during endovascular procedures were treated in the same interventional session by the stenting technique to control bleeding. All the aneurysms underwent endovascular exclusion without complications. Only one infected puncture site failed to heal within 2 months of stenting and was closed surgically 10 months later due to persistent localized graft infection, but with no further bleeding episodes. Only one aneurysm did not reabsorb within 3 months. Patients with painful skin ischemia had immediate pain relief. All patients also had stenosis in the draining veins necessitating additional percutaneous transluminal angioplasty. Only one patient required hospitalization (for intravenous antibiotic treatment of staphylococcal sepsis). No patients required a central catheter for hemodialysis. One access occluded due to cephalic arch stenosis in a noncompliant patient. Functional patency was 87% at 12 months, with a median follow-up of 15 months (range, 6.3 to 55.5 months).
CONCLUSION: Endovascular treatment with stent grafts in complicated access aneurysms is a simple, safe and rapid ambulatory procedure that enables treatment of both the aneurysm and its accompanying draining vein stenosis. It enables continued cannulation of the existing access and avoids the use of central catheters.
Authors:
David Shemesh; Ilya Goldin; Ibrahim Zaghal; Daniel Berelowitz; Anthony G Verstandig; Oded Olsha
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Publication Detail:
Type:  Journal Article     Date:  2011-06-12
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-05     Completed Date:  2011-11-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1088-94     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery and Vascular Access Center, Shaare Zedek Medical Center, Jerusalem, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care
Aneurysm / etiology,  physiopathology,  therapy*
Aneurysm, False / etiology,  physiopathology,  therapy*
Angioplasty / adverse effects,  instrumentation*
Arteriovenous Shunt, Surgical / adverse effects*
Child
Child, Preschool
Female
Humans
Israel
Male
Middle Aged
Pain / etiology
Pain Management
Prosthesis-Related Infections / etiology,  therapy
Punctures / adverse effects
Renal Dialysis*
Stents* / adverse effects
Time Factors
Treatment Outcome
Vascular Patency
Young Adult

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