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Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts

Open access
Haskal, Ziv J., Trerotola, Scott, Dolmatch, Bart, Schuman, Earl, Altman, Sanford, Mietling, Samuel, Berman, Scott, McLennan, Gordon, Trimmer, Clayton, Ross, John, Vesely, Thomas·2010·New England Journal of Medicine

Abstract

BACKGROUND: The leading cause of failure of a prosthetic arteriovenous hemodialysis-access graft is venous anastomotic stenosis. Balloon angioplasty, the first-line therapy, has a tendency to lead to subsequent recoil and restenosis; however, no other therapies have yet proved to be more effective. This study was designed to compare conventional balloon angioplasty with an expanded polytetrafluoroethylene endovascular stent graft for revision of venous anastomotic stenosis in failing hemodialysis grafts. METHODS: We conducted a prospective, multicenter trial, randomly assigning 190 patients who were undergoing hemodialysis and who had a venous anastomotic stenosis to undergo either balloon angioplasty alone or balloon angioplasty plus placement of the stent graft. Primary end points included patency of the treatment area and patency of the entire vascular access circuit. RESULTS: At 6 months, the incidence of patency of the treatment area was significantly greater in the stent-graft group than in the balloon-angioplasty group (51% vs. 23%, P<0.001), as was the incidence of patency of the access circuit (38% vs. 20%, P=0.008). In addition, the incidence of freedom from subsequent interventions at 6 months was significantly greater in the stent-graft group than in the balloon-angioplasty group (32% vs. 16%, P=0.03 by the log-rank test and P=0.04 by the Wilcoxon rank-sum test). The incidence of binary restenosis at 6 months was greater in the balloon-angioplasty group than in the stent-graft group (78% vs. 28%, P<0.001). The incidences of adverse events at 6 months were equivalent in the two treatment groups, with the exception of restenosis, which occurred more frequently in the balloon-angioplasty group (P<0.001). CONCLUSIONS: In this study, percutaneous revision of venous anastomotic stenosis in patients with a prosthetic hemodialysis graft was improved with the use of a stent graft, which appears to provide longer-term and superior patency and freedom from repeat interventions than standard balloon angioplasty. (ClinicalTrials.gov number, NCT00678249.)

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Crossref · 10.1056/nejmoa0902045

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Metadata

Authors
Haskal, Z. J., Trerotola, S., Dolmatch, B., Schuman, E., Altman, S., Mietling, S., Berman, S., McLennan, G., Trimmer, C., Ross, J., & Vesely, T.
Venue
New England Journal of Medicine
Published
2010-02-11
Volume
362
Issue
6
Pages
494-503
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W1982735089
Cited by
422
References
17
FWCI
46.20
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts. https://app.cochat.ai/papers/10.1056/nejmoa0902045
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Haskal, Z. J., Trerotola, S., Dolmatch, B., Schuman, E., Altman, S., Mietling, S., Berman, S., McLennan, G., Trimmer, C., Ross, J., & Vesely, T. (2010). Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts. New England Journal of Medicine. https://doi.org/10.1056/nejmoa0902045

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