Vascular
stenosis is most often the culprit behind
hemodialysis vascular access dysfunction, and although percutaneous transluminal angioplasty remains the gold standard treatment for vascular
stenosis, over the past decade the use of
stents as a treatment option has been on the rise. Aside from the 2 Food and Drug Administration-approved
stent grafts for the treatment of venous graft anastomosis
stenosis, use of all other
stents in vascular access dysfunction is off-label.
Kidney Disease Outcomes Quality Initiative recommends limiting
stent use to specific conditions, such as elastic lesions and recurrent
stenosis; otherwise, additional adapted indications are in procedure-related complications, such as grade 2 and 3
hematomas. Published reports have shown the potential use of
stents in a variety of conditions leading to vascular access dysfunction, such as venous graft anastomosis
stenosis, cephalic arch
stenosis, central venous
stenosis, dialysis access aneurysmal elimination, cardiac implantable electronic device-induced
stenosis, and thrombosed arteriovenous grafts. Although further research is needed for many of these conditions, evidence for recommendations has been clear in some; for instance, we know now that
stents should be avoided along cannulation sites and should not be used in eliminating dialysis access
aneurysms. In this review article, we evaluate the available evidence for the use of
stents in each of the aforementioned conditions leading to
hemodialysis vascular access dysfunctions.