The Use of Viatorr Stent at the Thoracic Outlet to Maintain Hemodialysis Access Function

Authors

Mohammad Ghasemi-Rad
Lauren Do
Michael Collard
Jai Cui
Zubin Irani

Publication Date

11-1-2023

Journal

Vascular and Endovascular Surgery

DOI

10.1177/15385744231183490

PMID

37310358

PMCID

PMC10543124

PubMedCentral® Posted Date

6-13-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Graft Occlusion, Vascular, Vascular Patency, Retrospective Studies, Treatment Outcome, Blood Vessel Prosthesis Implantation, Stents, Vascular Diseases, Renal Dialysis, Arteriovenous Shunt, Surgical

Abstract

PURPOSE: Venous steno-occlusive disease at the thoracic outlet affects up to 30% of the hemodialysis population [1] causing arm swelling and hemodialysis access dysfunction. Balloon angioplasty in this region can be of limited utility given the rigid compressive effect of surrounding musculoskeletal (MSK) structures. Outcomes of using the Viatorr endoprosthesis (Gore Viatorr TIPS Endoprosthesis, Gore, Flagstaff AR, USA, Viatorr ®) within this region to salvage the HD access in patients who presented with dialysis access dysfunction is presented.

METHODS: A retrospective chart review was performed of our tertiary and quaternary care hospital system. Hemodialysis patients were included in the study if they were using an upper extremity arteriovenous fistula or graft for access, had a Viatorr stent placed in the central (subclavian and/or brachiocephalic) veins, and had follow up.

RESULTS: A total of nine patients were identified to meet the inclusion criteria. Four interventions were due to refractory lesions of the subclavian or brachiocephalic veins, and the other five interventions were for hemodynamically significant lesions refractory to angioplasty alone, all resulting in access dysfunction. Primary patency ranged from 36-442 days (geometric mean 156.6 days, range 19-442 days). No stent fracture was identified on imaging at any point during follow-up of these patients out to a maximum of 2912 days (Average 837 days).

CONCLUSIONS: The Viatorr stent graft used in the HD population for clinically significant lesions at the thoracic outlet (TO) showed no structural failures (fractures) in this cohort.