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LAS VEGAS -- Percutaneous covered stents safely and effectively bypass and seal off pseudoaneurysms in arteriovenous grafts and fistulas, preventing rupture, prolonging hemodialysis access, and eliminating the need for open surgical repair, a prospective study of 24 patients has found.
"Endograft exclusion of PSAs [pseudoaneurysms] is a practical approach to solving a not uncommonly encountered clinical problem in this complex patient population. Patients avoid complications related to [surgery], and are able to maintain an uninterrupted dialysis pattern" without the use of a central venous catheter, lead investigator Alison Kinning said at the annual meeting of the Society for Clinical Vascular Surgery.
Twenty of the patients had arteriovenous grafts, four had arteriovenous fistulas, and all had at least one pseudoaneurysm. The patients were stented with Fluency e-polytetrafluoroethylene–covered nitinol stents using a bareback technique.
A 6-French sheath was placed after removal of the stent delivery catheter, and angioplasty was used in order to pleat out and fix the stent in place, with angioplasty for outflow stenosis also done as needed. Blood was drawn out of the aneurysm after the stent was in place in order to relieve skin tension.
"We allowed immediate [dialysis] cannulation, including the stented segment, following endograft placement. We did mark the center of the stent so as to avoid cannulation [of its ends]," noted Ms. Kinning, a third-year medical student at the American University of the Caribbean in St. Maarten.
Primary assisted patency was 100% in the 20 patients who completed a 2-month follow-up and in the 13 who completed a 6-month follow-up. The mean duration of patency was 17.6 months, and the longest duration of patency was 6 years, 4 months.
However, after 2 months one patient asked to have the stent removed because of pain, and two patients were restented after their initial stents fractured.
Five stented grafts had to be removed after a mean of 2.4 months because of infection. The cause of the infections is uncertain, but these probably occurred because of repeated cannulations, diabetes, poor personal hygiene, or other factors.
"Sometimes, the infection may have already started [before stenting], but you’ve at least prevented the [graft] from rupturing. Sometimes the stent will help you control an emergent or threatening situation and give you time to plan a repair or bypass if needed," said coauthor Dr. Wayne Kinning, a vascular surgeon in Flint, Mich., and Ms. Kinning’s father.
A handful of other studies have supported the use of stents in order to treat pseudoaneurysms.
One such study found that infections were associated with skin erosion over the aneurysm. In this retrospective review of medical records by Dr. Aamir Shah, patients with a PSA underwent endovascular repair using a stent graft. The indications for repair included PSA with symptoms, PSA with skin erosion, PSA with failed hemodialysis, and PSA after balloon angioplasty of a stenosis. (J. Vasc. Surg. 2012 [doi:10.1016/j.jjvs.2011.10.126]).
The procedure "probably will become increasingly recommended. I think that’s the shift that’s happening," said Dr. Kinning.
Ms. Kinning and Dr. Kinning said they had no relevant disclosures.
We have also been using this technique to salvage these grafts and fistulae. It is especially useful as a stop-gap measure. We have our own outpatient in-office suite and so we can treat a patient who comes to the office exsanguinating, place the graft, control the hemorrhage and then electively work the patient up for further treatment as necessary.
Dr. Russell H. Samson is Clinical Associate Professor of Surgery (Vascular) Florida State University Medical School, and Attending Vascular Surgeon, Sarasota Vascular Specialists. He is also an associate medical editor for Vascular Specialist.
We have also been using this technique to salvage these grafts and fistulae. It is especially useful as a stop-gap measure. We have our own outpatient in-office suite and so we can treat a patient who comes to the office exsanguinating, place the graft, control the hemorrhage and then electively work the patient up for further treatment as necessary.
Dr. Russell H. Samson is Clinical Associate Professor of Surgery (Vascular) Florida State University Medical School, and Attending Vascular Surgeon, Sarasota Vascular Specialists. He is also an associate medical editor for Vascular Specialist.
We have also been using this technique to salvage these grafts and fistulae. It is especially useful as a stop-gap measure. We have our own outpatient in-office suite and so we can treat a patient who comes to the office exsanguinating, place the graft, control the hemorrhage and then electively work the patient up for further treatment as necessary.
Dr. Russell H. Samson is Clinical Associate Professor of Surgery (Vascular) Florida State University Medical School, and Attending Vascular Surgeon, Sarasota Vascular Specialists. He is also an associate medical editor for Vascular Specialist.
LAS VEGAS -- Percutaneous covered stents safely and effectively bypass and seal off pseudoaneurysms in arteriovenous grafts and fistulas, preventing rupture, prolonging hemodialysis access, and eliminating the need for open surgical repair, a prospective study of 24 patients has found.
"Endograft exclusion of PSAs [pseudoaneurysms] is a practical approach to solving a not uncommonly encountered clinical problem in this complex patient population. Patients avoid complications related to [surgery], and are able to maintain an uninterrupted dialysis pattern" without the use of a central venous catheter, lead investigator Alison Kinning said at the annual meeting of the Society for Clinical Vascular Surgery.
Twenty of the patients had arteriovenous grafts, four had arteriovenous fistulas, and all had at least one pseudoaneurysm. The patients were stented with Fluency e-polytetrafluoroethylene–covered nitinol stents using a bareback technique.
A 6-French sheath was placed after removal of the stent delivery catheter, and angioplasty was used in order to pleat out and fix the stent in place, with angioplasty for outflow stenosis also done as needed. Blood was drawn out of the aneurysm after the stent was in place in order to relieve skin tension.
"We allowed immediate [dialysis] cannulation, including the stented segment, following endograft placement. We did mark the center of the stent so as to avoid cannulation [of its ends]," noted Ms. Kinning, a third-year medical student at the American University of the Caribbean in St. Maarten.
Primary assisted patency was 100% in the 20 patients who completed a 2-month follow-up and in the 13 who completed a 6-month follow-up. The mean duration of patency was 17.6 months, and the longest duration of patency was 6 years, 4 months.
However, after 2 months one patient asked to have the stent removed because of pain, and two patients were restented after their initial stents fractured.
Five stented grafts had to be removed after a mean of 2.4 months because of infection. The cause of the infections is uncertain, but these probably occurred because of repeated cannulations, diabetes, poor personal hygiene, or other factors.
"Sometimes, the infection may have already started [before stenting], but you’ve at least prevented the [graft] from rupturing. Sometimes the stent will help you control an emergent or threatening situation and give you time to plan a repair or bypass if needed," said coauthor Dr. Wayne Kinning, a vascular surgeon in Flint, Mich., and Ms. Kinning’s father.
A handful of other studies have supported the use of stents in order to treat pseudoaneurysms.
One such study found that infections were associated with skin erosion over the aneurysm. In this retrospective review of medical records by Dr. Aamir Shah, patients with a PSA underwent endovascular repair using a stent graft. The indications for repair included PSA with symptoms, PSA with skin erosion, PSA with failed hemodialysis, and PSA after balloon angioplasty of a stenosis. (J. Vasc. Surg. 2012 [doi:10.1016/j.jjvs.2011.10.126]).
The procedure "probably will become increasingly recommended. I think that’s the shift that’s happening," said Dr. Kinning.
Ms. Kinning and Dr. Kinning said they had no relevant disclosures.
LAS VEGAS -- Percutaneous covered stents safely and effectively bypass and seal off pseudoaneurysms in arteriovenous grafts and fistulas, preventing rupture, prolonging hemodialysis access, and eliminating the need for open surgical repair, a prospective study of 24 patients has found.
"Endograft exclusion of PSAs [pseudoaneurysms] is a practical approach to solving a not uncommonly encountered clinical problem in this complex patient population. Patients avoid complications related to [surgery], and are able to maintain an uninterrupted dialysis pattern" without the use of a central venous catheter, lead investigator Alison Kinning said at the annual meeting of the Society for Clinical Vascular Surgery.
Twenty of the patients had arteriovenous grafts, four had arteriovenous fistulas, and all had at least one pseudoaneurysm. The patients were stented with Fluency e-polytetrafluoroethylene–covered nitinol stents using a bareback technique.
A 6-French sheath was placed after removal of the stent delivery catheter, and angioplasty was used in order to pleat out and fix the stent in place, with angioplasty for outflow stenosis also done as needed. Blood was drawn out of the aneurysm after the stent was in place in order to relieve skin tension.
"We allowed immediate [dialysis] cannulation, including the stented segment, following endograft placement. We did mark the center of the stent so as to avoid cannulation [of its ends]," noted Ms. Kinning, a third-year medical student at the American University of the Caribbean in St. Maarten.
Primary assisted patency was 100% in the 20 patients who completed a 2-month follow-up and in the 13 who completed a 6-month follow-up. The mean duration of patency was 17.6 months, and the longest duration of patency was 6 years, 4 months.
However, after 2 months one patient asked to have the stent removed because of pain, and two patients were restented after their initial stents fractured.
Five stented grafts had to be removed after a mean of 2.4 months because of infection. The cause of the infections is uncertain, but these probably occurred because of repeated cannulations, diabetes, poor personal hygiene, or other factors.
"Sometimes, the infection may have already started [before stenting], but you’ve at least prevented the [graft] from rupturing. Sometimes the stent will help you control an emergent or threatening situation and give you time to plan a repair or bypass if needed," said coauthor Dr. Wayne Kinning, a vascular surgeon in Flint, Mich., and Ms. Kinning’s father.
A handful of other studies have supported the use of stents in order to treat pseudoaneurysms.
One such study found that infections were associated with skin erosion over the aneurysm. In this retrospective review of medical records by Dr. Aamir Shah, patients with a PSA underwent endovascular repair using a stent graft. The indications for repair included PSA with symptoms, PSA with skin erosion, PSA with failed hemodialysis, and PSA after balloon angioplasty of a stenosis. (J. Vasc. Surg. 2012 [doi:10.1016/j.jjvs.2011.10.126]).
The procedure "probably will become increasingly recommended. I think that’s the shift that’s happening," said Dr. Kinning.
Ms. Kinning and Dr. Kinning said they had no relevant disclosures.
Major Finding: Following stenting of hemodialysis graft pseudoaneurysms, primary assisted patency was 100% in the 20 patients who completed a 2-month follow-up and in the 13 who completed a 6-month follow-up.
Data Source: A prospective series of 24 patients was studied.
Disclosures: Ms. Kinning and Dr. Kinning said they had no relevant financial disclosures.