JVA ISSN 1129-7298 https://doi.org/ The Journal of Vascular Access 2018, Vol. 19(1) 76–83 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.5301/jva.5000823 journals.sagepub.com/home/jva JVA Te Journal of Vascular Access ORIGINAL RESEARCH ARTICLE Several complicatons are associated with the chronic use of hemodialysis access such as pseudoaneurysm formaton, steal syndrome, thrombosis, stenosis and occlusion at the ve- nous outlow; therefore, each access has a limited lifespan and should be preserved as much as possible (1). Endovascular approaches to deal with dysfunctonal AVFs and AVGs are the primary treatment choice. These interven- tons can help delay the abandonment of access circuits and avoid the use of CVCs. Recently, the use of stent placement for hemodialysis cir- cuit dysfuncton treatment is becoming more frequent, due to high primary and secondary patency, when a stent-graf is placed in the venous anastomosis of AVGs and in the venous outlow tract in AVFs (2, 3). In the present study we evaluated the efcacy of the heparin bioactve surface (HBS) Viabahn Stent (W.L. Gore & Associates, Flagstaf, Arizona) in the maintenance or re- establishment of hemodialysis access. Viabahn stent for hemodialysis shunt: efcacy, long segment recanalizaton and prognostc factors for reinterventon Giancarlo Salsano 1 , Mateo Trezzi 2 , Mateo Baratni 1 , Franca Pucciant 1 , Nicola Romano 1 , Tito Zatera 2 , Nadia Chiappini 2 , Francesco Londrino 3 , Davide Rolla 2 , Teseo Stefanini 1 1 Unit of Radiology and Interventonal Radiology, General Hospital Sant’Andrea, La Spezia - Italy 2 Departments of Nephrology and Dialysis, General Hospital Sant’Andrea, La Spezia - Italy 3 Departments of Nephrology and Dialysis, General Hospital Sant’Eugenio, Rome - Italy Introducton The surgical creaton of arteriovenous circuits, includ- ing autogenous arteriovenous fstulas (AVFs) and prosthesis arteriovenous grafs (AVGs), is widely recognized as a standard of choice for hemodialysis access over the usage of central venous catheters (CVCs), which have high complicaton rates. ABSTRACT Introducton: The study evaluated the Heparin Bioactve Surface (HBS) Viabahn Stent (W.L. Gore & Associates, Flagstaf, Arizona) efcacy in the maintenance or re-establishment of hemodialysis. Materials and methods: Fify HBS Viabahn stents deployed in 37 consecutve patents with hemodialysis dysfunc- ton from January 2008 to May 2016 were evaluated in a single-insttuton retrospectve review. Outcomes were stent patency intended as primary circuit patency (PP), assisted primary patency (APP), target lesion primary patency (TLPP) and secondary patency (SP). Moreover, the risk factor analysis for hemodialysis dysfuncton that required reinterventon was performed. A subgroup analysis was conducted to assess patency of Viabahn stent to treat peripheral venous long segment obstructon (LSO). Results: Overall Kaplan-Meyer PPs were 60% at 12 months and 42% at 24 months. Overall TLPP estmated rates were 68% and 49% at 12 and 24 months, respectvely. The corresponding SP rates were 85% and 78% at the same period. Estmated PP rates at 12 and 24 months for stent placement afer peripheral venous long segment recana- lizaton procedure were 53% and 31%, respectvely. Corresponding SP rates were 82% and 68%, respectvely. The APP rates were 79% at 12 months and 61% at 24 months. Female sex, access age and thrombosis were associated with reduced primary patency. Conclusions: Considering the high rates of PP, TLPP, APP and SP, Viabahn stents have been proven efectve in main- taining or re-establishing the hemodialysis access. Moreover, stent placement afer recanalizaton of LSO of venous out-fow represented a valid approach to rescue a dysfunctonal fstula that would otherwise be abandoned. Keywords: Assisted primary patency, Long segment recanalizaton, Primary circuit patency, Primary target lesion patency, Secondary patency Accepted: September 24, 2017 Published online: November 25, 2017 Corresponding author: Giancarlo Salsano Unit of Radiology and Interventonal Radiology General Hospital Sant’Andrea Via Veneto 197 19124, La Spezia, Italy giancarlo.salsano@yahoo.it