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Kidney Week

Abstract: PO1346

Efficacy and Long-Term Patency of Kissing Stent Technique for Endovascular Reconstruction of the Axillary Vein: A Case Report with Long-Term Follow-Up

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Akram, Sami M., Nephrology Associates of Northern Illinois and Indiana, Oak Brook, Illinois, United States
  • Saleem, Khurram, Nephrology Associates of Northern Illinois and Indiana, Oak Brook, Illinois, United States
  • Rahman, Mohamed A., Nephrology Associates of Northern Illinois and Indiana, Oak Brook, Illinois, United States
Background

Purpose: to report the endovascular reconstruction (EVR) of axillary vein (AXV) with kissing stent technique (KST) following AXV obstruction due to proximal stent migration (PSM) from the cephalic arch (CA). We suggest a strategy to minimize this problem.
PSM in venous system is rare but dreadful complication of EVR. Increasing venous sizes towards the heart predisposes to PSM. We report a case of AXV obstruction due to stent migration into subclavian vein (SCV). We describe the successful use of kissing stent technique (KST) to reconstruct the AXV.

Methods

Case report and review of literature.

Results

Case report: MS is an 81-yr-old female with right brachiocephalic arteriovenous fistula (R BCAVF) for chronic hemodialysis. She has recurrent cephalic arch stenosis (RCAS) (Fig1). A Viabhan 11 x 5 stent was placed which, partially migrated into the SCV, blocking the AXV (Fig2 & Fig3). The Basilic vein (BV) was cannulated and a straight glide wire introduced. A Luminex 10 x 6 stent was delivered next to Viabhan stent in the AXV. Both stents were expanded with 10 x 4 angioplasty balloon restoring the forward flow in the AXV (Fig4). At 5-year follow up both stents were patent (Fig5) except for pre and post stent stenosis, successfully treated with angioplasty.
Discussion: EVR is employed to treat RCAS1,2. However, there is risk of PSM. A strategy we implement to reduce PSM is to avoid complete dilatation of lesion prior to stenting which, in this case prevented full migration of the stent. KST for EVR of superior vena cava3 and common iliac veins4 has been reported but not for EVR of AXV. We report the first case of utilizing KST for EVR of the AXV with 5-year follow up.

Conclusion

KST for EVR of the Axillary vein is technically feasible and has long term efficacy.

Partially migrated stent

KST

Funding

  • Private Foundation Support