Bard's Fluency Plus Shows Effectiveness in Treatment of Dysfunctional AV Access Circuits

April 9, 2012—In the Journal of Vascular and Interventional Radiology, Bart L. Dolmatch, MD, et al published findings from a study using the Fluency Plus stent graft (Bard Peripheral Vascular, Tempe, AZ) to review technical and 180-day clinical outcomes in the treatment of dysfunctional arteriovenous (AV) hemodialysis access circuits (2012;23:479-487).

According to the investigators, the Fluency Plus device was used to salvage percutaneous transluminal angioplasty (PTA) technical failures and complications in AV access circuits over 2 years. There were 106 patients treated with 138 stent grafts. Indications for stent graft use included residual stenosis after PTA (n = 81), extravasation after PTA (n = 22), early recurrent stenosis (n = 14), pseudoaneurysms (n = 4), and “other” (n = 4). Data were retrospectively analyzed for complications and outcomes.

As detailed in the Journal of Vascular and Interventional Radiology, technical success was achieved in all patients, and clinical success was achieved in 104 (98%) of 106 patients. At 180 days, postintervention primary patency (PIPP) was 47%, and postintervention secondary patency (PISP) was 79%. PIPP was 62% for autogenous fistulas (AVFs) and 35% for prosthetic grafts (AVGs) (P = .010). The 180-day PIPP for stent grafts 9-10 mm in diameter was 63% versus 38% for stent grafts 6-8 mm in diameter (P = .012). Implants that did not cross the elbow had a 180-day PIPP of 47% compared with 25% for implants across the elbow (P = .032). Technical complications were periprocedure AVG thromboses (n = 2), intraprocedural stent graft dislodgment (n = 1), venospasm (n = 2), and contrast agent-related hives (n = 1). One patient returned at 2 months with an infected AVG and stent graft in the outflow vein.

The investigators concluded that the Fluency Plus stent graft was effective for maintenance of hemodialysis access circuit patency and was comparable or better than historical outcomes for PTA and bare stents. Factors that favored improved patency included larger diameter devices, use in AVFs, and avoiding placement across the elbow joint.