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44. Evaluation of expanded polytetrafluoroethylene-covered stents for the treatment of venous outflow stenosis in hemodialysis access grafts.

Author

Chan MG, Miller FJ, Valji K, Kuo MD, Chan, Michael G, Miller, Frank J, Valji, Karim, and Kuo, Michael D

Abstract

Purpose: To investigate the use of an expanded polytetrafluoroethylene-coated nitinol stent-graft in patients with failing hemodialysis access circuits and compare grafts with and without a heparin-coated surface.Materials and Methods: A single-institution retrospective review of 16 patients (average age, 55 years; seven men) treated for hemodialysis access circuit stenoses was performed. Patients had a prosthetic arteriovenous (AV) graft (n = 10) or autogenous AV fistula (n = 6), all with clinically relevant access stenoses that were refractory to angioplasty alone; 10 patients also had access circuit thrombosis at the time of treatment. Stents were placed in the basilic (n = 4), brachial (n = 7), cephalic (n = 4), and femoral (n = 1) veins. Study endpoints included primary treatment area patency, primary circuit patency, primary assisted circuit patency, and secondary circuit patency, followed to a maximum of 6 months.Results: Primary treatment area patency rates at 30 days and 180 days were 75% and 31%, respectively. Secondary patency rates at the same time points were 88% and 68%, respectively. Mean primary treatment area patency was 93 days. Thrombosis was a major cause of failure, occurring in seven of 11 cases of primary treatment area patency loss. Subgroup analysis demonstrated that the heparin-coated configuration (n = 7) showed a 6-month primary patency rate of 57%, compared with 11% for the stent-grafts without heparin bonding (n = 9; P = .06).Conclusions: Overall, the majority of deployed stent-grafts lost primary patency within 6 months, with thrombosis a major cause of failure. However, the addition of a heparin-coated surface appeared to improve results in these otherwise treatment-refractory access circuits. [ABSTRACT FROM AUTHOR]

Published
2011
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47. Pulse-spray pharmacomechanical thrombolysis.

Author

Bookstein, Joseph, Valji, Karim, Bookstein, J J, and Valji, K

Abstract

The synergistic potential of combining pharmacologic and mechanical methods of thrombolysis has recently been recognized. Pulse-spray pharmacomechanical thrombolysis is one such method, which in our experience has markedly increased the efficiency and acceptability of thrombolysis. With this technique, dialysis grafts usually require only 20-35 min for thrombolysis; bypass grafts or native arteries usually require 60-150 min. The entire procedure is accomplished in one session within the angiography suite, including the supplemental transluminal angioplasty, atherectomy, or stenting that is usually also necessary. Clear understanding of the principle of the method and meticulous attention to technical details is essential for maximal speed, safety, and efficacy. [ABSTRACT FROM AUTHOR]

Published
1992
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50. Journal of Vascular and Interventional Radiology

Author

Nemcek Jr, A. A., Matsumoto, A. H., Stainken, B. F., Trerotola, S. O., Bakal, C. W., Wright, K. C., Kee, S. T., Burrows, P. E., Laberge, J. M., Duncan, J. R., Geschwind, J. H., Siskin, G. P., Stein, M., Teitelbaum, G. P., Rilling, W. S., Omary, R. A., Gray, R. J., Valji, K., Dolmatch, B. L., Tan, L., Matthew Mauro, Andrews, J. C., Barth, K. H., Kerlan Jr, R. K., Kandarpa, K., Bakal, C., Darcy, M., Brunner, M. C., Durham, J. D., Kaufman, J. A., Krol, K. L., Lewis, C., Marx, M. V., Matalon, T. A. S., Raabe, R. D., Rholl, K. S., Roberts, A., Russell, E. J., Soulen, M., Beatty, P. T., Consigny, P. M., Culp, W. C., Goodwin, S. C., Leveen, R. F., Rundback, J. H., Keller, F. C., Baum, S., Pomerantz, P., Mcclenny, T., Birnie, M., Addai, A., Allen, P., Bikowski, H., Dowd, S., Galstan, B., Gornal, J., Hillier, B. J., Hopkins, D., Katsarelis, D., King, S., Landow, W., Lanzirotti, J., Mabry, M., Mendelsohn, C., Richards, J., Shnitzler, D., Siler, S., Strain, C., and White, P.

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