Dialysis Patient's Access Improved by Stenting

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According to a 12 month study, Chronic Kidney Disease (CKD) patients on dialysis derive long-term benefit from the minimally invasive placement of a stent that improves the function of dialysis access grafts.

Dialysis is very demanding, and anything that prevents access sites from failing and reduces the need for invasive treatments of surgery will dramatically improve patients' quality of life. Every year nearly 400,000 people undergo dialysis. The blood is accessed and filtered through delicate grafts or veins that often collapse because they cannot handle the high-pressure circuit of purified blood being fed back into the body, forcing them to be continually reopened or having to create new treatment access sites. Results show that these dialysis sites can be successfully kept open using tiny scaffolds called stent grafts for far longer than previously reported.

In a study of 270 dialysis patients who were treated for collapsed access sites, 138 underwent stent grafts while the remaining 132 had balloon angioplasty. After a12 month follow-up, researchers found that two and half times more patients in the stent graft group had continual use of their dialysis access grafts while those who were being treated by balloon angioplasty alone (without invasive interim procedures) did not. Until this data, grafts had been considered short-term solutions, with 75 percent requiring invasive interventions in under a year. An estimated 1 in 10 Americans has some form of chronic kidney disease, according to the National Institutes of Health. End-stage renal disease means the kidneys have failed and can no longer filter waste products from the blood. This condition is fatal without a kidney transplant or dialysis to prevent blood poisoning. An arteriovenous fistula is the gold standard for dialysis access and involves creating a natural blood vessel bypass, but many patients, especially those who are too ill to undergo the invasive surgery, have an arteriovenous graft—a plastic tube sewn into the vein, which easily clogs.

There is particular turbulence in the area where the graft is sewn that allows blood to flow back up the arm toward the heart. That turbulence tends to incite tissue growth at the sides. These veins thicken and narrow just like a river depositing sediment along a bend. More than 100,000 angioplasties are performed a year due to this narrowing. What this stent method does is not only reopen the vein, but turn the graft into an inline flow, so that the blood enters the vein at a more natural angle.

The stents are made of a medical-grade plastic which are implanted at the time of balloon angioplasty. It is a minimally invasive technique that interventional (surgical) radiologists perform, using just a small incision and medical imaging to guide a small inflated balloon which expands the vein to set the stent in place. The resulting reduction of wear and tear due to these stent grafts helps dialysis access sites stay healthy and open for much longer than expected. For example, there are stent grafts that are still open after three years. This controlled study proves that durable long-term solutions for CKD patients can be achieved, reducing their invasive procedures and thus improving their quality of life.

Read more: http://medicalxpress.com/news/2013-04-stenting-treatment-access-dialysis-patients.html#jCp

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