Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts

In this randomized, multicenter trial, patients with a venous anastomotic stenosis who were undergoing hemodialysis were assigned to undergo balloon angioplasty or placement of a stent graft. Primary end points included patency of the treatment area and patency of the entire vascular access circuit. Percutaneous revision was improved with the use of a stent graft, which appeared to provide durable and superior patency and freedom from repeat interventions. Patients with a venous anastomotic stenosis who were undergoing hemodialysis were assigned to undergo balloon angioplasty or placement of a stent graft. Percutaneous revision was improved with the use of a stent graft, which appeared to provide durable and superior patency and freedom from repeat interventions. By 2008, more than 341,000 patients in the United States were undergoing hemodialysis for treatment of their end-stage renal disease. 1 The National Kidney Foundation Kidney Disease Outcomes Quality Initiative seeks to increase the use of autogenous fistulas, yet many patients continue to undergo hemodialysis with the use of prosthetic arteriovenous grafts. The reasons for this discrepancy between the recommendation and practice are multifactorial and continue to be debated. 2 , 3 The costs of maintaining vascular access are substantial; for example, the cost of treating a patient who has failure of a hemodialysis access graft is significantly higher ($62,000 per patient-year) than . . .