Real-World Experience with the Viabahn-Covered Stent in the Cephalic Arch Vein of the Native Arteriovenous Fistula

Objectives: To investigate the real-world outcomes of the Viabahn-covered stent for the treatment of cephalic arch vein stenosis in arteriovenous fistula. The current therapeutic options for cephalic arch vein stenoses lack durability, leading to frequent re-intervention or loss of the vascular access. Methods: Cephalic vein arch angioplasty and placement of the Viabahn-covered stent (Gore, Flagstaff, Arizona, USA) at multiple centers. Patients were followed up at 1, 3, and 6 months to detect fistula dysfunction, to evaluate safety, and to evaluate restenosis rate. Results: Ten patients were treated for fistula dysfunction which included high venous pressures, low dialysis blood flows, and prolonged bleeding after de-cannulation. Ten stents were used in total, with a median stent diameter of 10 mm and length of 10 cm. Immediate technical success was 100%. Immediate restoration of normal access function was restored in 100% of patients. During a mean follow-up of 6 months, one patient had died from unrelated causes; all other patients were available for review. Two patients required re-angioplasty of the Viabahn stent postinitial intervention for high venous pressures and low dialysis pump flows, respectively. Two other patients required angioplasty of the fistula but not the covered stent segment postinitial procedure. All other patients were dialyzing effectively. No stent infections were seen during the follow-up period. Conclusion: Six-month follow-up demonstrates excellent safety and preservation of dialysis function using the Viabahn-covered stent to treat cephalic arch vein stenosis.

Publication History

Article published online:
26 April 2021