Semin intervent Radiol 2009; 26(2): 089-095
DOI: 10.1055/s-0029-1222451
© Thieme Medical Publishers

Treatment of Hemodialysis Graft Pseudoaneurysms with Stent Grafts: Institutional Experience and Review of the Literature

Lauren R. Pandolfe1 , Angelo P. Malamis2 , Kenneth Pierce2 , Marc A. Borge2
  • 1Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
  • 2Department of Radiology, Loyola University Medical Center, Maywood, Illinois
Weitere Informationen


29. Juni 2009 (online)


Hemodialysis access grafts are an important component of the treatment of patients with renal failure. Because access sites are limited, maximizing graft lifespan is of major importance to dialysis patients. Pseudoaneurysm formation is a rare, but important complication potentially limiting the longevity of dialysis grafts. With rapidly advancing technology, placement of stent grafts in patients with end-stage renal disease is an important step in prolonging the life of the graft. We conducted a review of the literature regarding stent-graft use for hemodialysis access. In addition, we looked at our experience utilizing the Viabahn® (W. L. Gore & Associates, Newark, DE) stent graft in pseudoaneurysm repair. Our patients achieved primary patency of their grafts for 1, 5, and 9 months, respectively. No complications related to stent-graft implementation have been encountered in six stent-graft implants over the course of 29 months.


  • 1 Aruny J E, Lewis C A, Cardella J F et al.. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology.  J Vasc Interv Radiol. 1999;  10(4) 491-498
  • 2 Rodriguez H E, Leon L, Schalch P, Labropoulous N, Borge M, Kalman P G. Arteriovenous access: managing common problems.  Perspect Vasc Surg Endovasc Ther. 2005;  17 155-166
  • 3 Barshes N R, Annambhotla S, Bechara C et al.. Endovascular repair of hemodialysis graft-related pseudoaneurysm: an alternative treatment strategy in salvaging failing dialysis access.  Vasc Endovascular Surg. 2008;  42(3) 228-234
  • 4 National Kidney Foundation .K/DOQI clinical practice guidelines for vascular access. Available at: Accessed November 9, 2008
  • 5 Cinat M E, Hopkins J, Wilson S E. A prospective evaluation of PTFE graft patency and surveillance techniques in hemodialysis access.  Ann Vasc Surg. 1999;  13(2) 191-198
  • 6 Roy-Chaudhury P, Kelly B S, Melhem M et al.. Vascular access in hemodialysis: issues, management, and emerging concepts.  Cardiol Clin. 2005;  23(3) 249-273
  • 7 Hausegger K A, Tiessenhausen K, Klimpfinger M, Raith J, Hauser H, Tauss J. Aneurysms of hemodialysis access grafts: treatment with covered stents: a report of three cases.  Cardiovasc Intervent Radiol. 1998;  21(4) 334-337
  • 8 Lin P H, Johnson C K, Pullium J K et al.. Transluminal stent graft repair with Wallgraft endoprosthesis in a porcine arteriovenous graft pseudoaneurysm model.  J Vasc Surg. 2003;  37(1) 175-181
  • 9 Najibi S, Bush R L, Terramani T T et al.. Covered stent exclusion of dialysis access pseudoaneurysms.  J Surg Res. 2002;  106(1) 15-19
  • 10 Rhodes E S, Silas A M. Dialysis needle puncture of Wallgrafts placed in polytetrafluoroethylene hemodialysis grafts.  J Vasc Interv Radiol. 2005;  16(8) 1129-1134
  • 11 Ryan J M, Dumbleton S A, Doherty J, Smith T P. Technical innovation. Using a covered stent (Wallgraft) to treat pseudoaneurysms of dialysis grafts and fistulas.  AJR Am J Roentgenol. 2003;  180(4) 1067-1071
  • 12 Silas A M, Bettmann M A. Utility of covered stents for revision of aging failing synthetic hemodialysis grafts: a report of three cases.  Cardiovasc Intervent Radiol. 2003;  26(6) 550-553
  • 13 Vesely T M. Use of stent grafts to repair hemodialysis graft-related pseudoaneurysms.  J Vasc Interv Radiol. 2005;  16(10) 1301-1307
  • 14 Clark T WI. Nitinol stents in hemodialysis access.  J Vasc Interv Radiol. 2004;  15(10) 1037-1040
  • 15 Vogel P M, Parise C. Comparison of SMART stent placement for arteriovenous graft salvage versus successful graft PTA.  J Vasc Interv Radiol. 2005;  16(12) 1619-1626
  • 16 Vogel P M, Parise C. SMART stent for salvage of hemodialysis access grafts.  J Vasc Interv Radiol. 2004;  15(10) 1051-1060
  • 17 Sapoval M R, Turmel-Rodrigues L A, Raynaud A C, Bourquelot P, Rodrigue H, Gaux J C. Cragg covered stents in hemodialysis access: initial and midterm results.  J Vasc Interv Radiol. 1996;  7(3) 335-342
  • 18 Moszkowicz A, Behrens G, Gueyikian S, Patel N, Ferral H. Occlusion of a rapidly expanding hemodialysis graft pseudoaneurysm with placement of a stent graft.  Semin Intervent Radiol. 2007;  24 34-37
  • 19 Criado E, Marston W A, Ligush J, Mauro M A, Keagy B A. Endovascular repair of peripheral aneurysms, pseudoaneurysms, and arteriovenous fistulas.  Ann Vasc Surg. 1997;  11(3) 256-263
  • 20 Farber A, Barbey M M, Grunert J H, Gmelin E. Access-related venous stenoses and occlusions: treatment with percutaneous transluminal angioplasty and Dacron-covered stents.  Cardiovasc Intervent Radiol. 1999;  22(3) 214-218
  • 21 Hein A N, Vesely T M. Use of the percutaneous thrombolytic device for the treatment of thrombosed pseudoaneurysms during mechanical thrombectomy of hemodialysis grafts.  J Vasc Interv Radiol. 2002;  13 201-204
  • 22 Sullivan K L, Besarab A, Bonn J, Shapiro M J, Gardiner Jr G A, Moritz M J. Hemodynamics of failing dialysis grafts.  Radiology. 1993;  186(3) 867-872

Angelo P MalamisM.D. 

Assistant Professor, Department of Radiology

2160 S. 1st Avenue, Maywood, IL 60153