HDA 2. Use of Covered Stents in Central Vein Stenosis After Vascular Accesses

Percutaneous transluminal angioplasty (PTA) in central vein stenosis represents the first therapeutic option, although high rates of restenosis are present. The aim of the study was to present our experience in using nitinol-polytetrafluoroethylene covered stents in the treatment of central vein stenosis. We conducted a retrospective study (April 2015-May 2018) of 27 patients with native or prosthetic vascular accesses with significant stenosis at the venous side. All patients underwent covered stent placement (Covera [Bard Peripheral Vascular, Tempe, Ariz], Viabahn [W. L. Gore & Associates, Flagstaff, Ariz]) followed by high-pressure PTA. Patients’ characteristics, previous procedures, stent type, complications, reinterventions, and vascular access patency (at months 1, 6, 12, 18, and 24) were examined. There were 27 patients (mean age, 62 years) who underwent covered stent placement (16 Viabahn, 13 Covera). In two cases, both stents were placed. Six patients had already been subjected to PTA because of recurrent stenosis; 21 had primitive stenosis. There were no perioperative complications. The patients were examined at 1 month, 6 months, 12 months, 18 months, and 24 months with clinical evaluation and ultrasound scan. Primary patency at 1 month, 6 months, 12 months, 18 months, and 24 months was 100%, 88%, 71%, 63%, and 58%, respectively. Primary assisted patency and secondary patency have been evaluated: 72% and 74%, respectively, at 24 months. A covered stent in venous stenosis after vascular access is effective in treating complications and prolonging the life of the access, especially in prosthetic accesses, whose primary patency is 60% to 65% after 1 year in the literature data. There were no major complications in our experience, even if patients had multiple comorbidities. A larger number of patients during long-term follow-up are needed to obtain an exhaustive experience.