O-189 - PRELIMINARY RESULT OF MULTICENTRIC TRESTAR STUDY (TREATING STENOSIS AND THROMBOTIC OCCLUSION OF AV ACCESS: REVISION BY USING EPTFE STENT GRAFTS WITH HEPARIN COVALENT BONDED SURFACE).

TOPIC:
Vascular Access
AUTHORS:
Palermo V. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Bandiera A. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Sala G. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Cervarolo M.C. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Franchin M. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Piffaretti G. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy) , Tozzi M. (Vascular Surgery, Asst-settelaghi University Hospital, Department of Medicine and Surgery - University of Insubria ~ Varese ~ Italy)
Introduction:
The aim of this study is to report the long-term results of ePTFE self-expandable stentgraft with heparin covalent bonded in prosthetic vascular access (AVG) and native vascular access (AVA) in patients with end-stage renal disease on hemodialysis, treated both for asymptomatic ⩾50% or symptomatic stenosis causing malfunctions of the vascular access with early recoil of the lesion after angioplasty. In addition, we enrolled patients treated for bleeding caused by rupture of the target vessels during angioplasty.
Methods:
This is a multicentric, retrospective, observational study conducted at four Italian centers: Varese, Desenzano, Pavia and Padova. For this study we identify all patients treated with ePTFE self-expandable stentgraft with heparin covalent bonded surface. Between January 2016 and December 2021, all the consecutive patients who underwent implantation of ePTFE self-expandable stentgraft were included in the study. Primary and secondary patency rate and complications were recorded. We perform routinely clinical evaluation and ultrasound examination to detect signs or images of stenosis: the absence of thrill and pulsatility, increasing bleeding time after needle removal, were considered as predictors of stenosis presence. Evaluation focused on arterial flow and Doppler flow volume estimation, study of the anastomosis and study of the venous outflow. All changes in haemodynamical data trends during haemodialysis are investigated with ultrasound examination. Otherwise, a routine evaluation by colour Doppler imaging is performed in all subjects every 2-3 months.
Results:
459 self-expandable stentgraft were implanted in 334 patients, 198 (59.3%) of whom were male and 136 (40.7%) females. The target vessels were basilic vein (n=199, 43.4%), axillary vein (n=39, 8.6%), cephalic vein (n=145, 31.7%), subclavian vein (n=26, 5.7%), innominate vein (n=30, 6.5%), and sutureless anastomosis (n=19, 4.1%). Autogenous vascular access was involved in 173 cases (37.7%) and prosthetic vascular access in 286 cases (62.3%). Secondary patency rate of vascular access was 95.3% ± 6 at 6 and 12 months. Pseudoaneurysm, bleeding, or graft infection was never observed in our expernience.
Conclusion:
ePTFE self-expandable stentgraft with heparin covalent bonded surface was useful and safe. Secondary patency of vascular access is satisfactory in the long-term.