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University of Maryland Study Finds Longer-Term Benefit with Stents for Dialysis Access Portals

Monday, April 15, 2013

Ziv J. Haskal, MD
 Ziv J. Haskal, MD
 

Stenting Improves Access to Blood Vessels for Kidney Failure Patients on Dialysis Compared to Angioplasty Alone

New Orleans – April 15, 2013.  University of Maryland School of Medicine researchers have found longer-term benefit with using a stent to keep blood vessels open for patients on kidney dialysis, a lifesaving treatment to remove toxins from the blood when the kidneys are unable to do so.  Results of the 12-month, national study are being presented at the Society of Interventional Radiology’s 38th Annual Scientific Meeting in New Orleans.

“This research has shown dramatic improvement by the use of this stent device to keep open the dialysis access portal —patients had far fewer invasive procedures and less interruption of dialysis, which can mean better health and quality of life,” explains lead author Ziv J. Haskal, MD, professor of diagnostic radiology and nuclear medicine, and surgery at the University of Maryland School of Medicine.

According to the researchers, nearly 400,000 Americans undergo hemodialysis annually.  These kidney dialysis patients often need repeated procedures, such as balloon angioplasty, to open the standard access portals, also known as grafts, which can become blocked or narrowed at the point where dialysis machines connect to the body. Over 100,000 estimated balloon angioplasties are performed each year to keep these grafts open - procedures that can be both painful and costly.

“The results of the multicenter randomized trial study exceeded our expectations and showed that these stents can keep open dialysis sites for longer than previously believed. Until this research, these grafts had been considered short-term tools for dialysis,” adds Dr. Haskal, a senior research advisor for the Division of Vascular and Interventional Radiology at the University of Maryland School of Medicine. 

The study looked at 270 dialysis patients treated for collapsed access sites at 28 centers in the United States. These kidney failure patients had synthetic grafts embedded in their arms that work like artificial blood vessels, allowing needles to be inserted repeatedly to filter the blood. The turbulence of the blood during this filtering often causes the blockages and scar tissue, which impedes treatment.

During the trial, 138 patients received stent grafts, which are small metal scaffolds inserted into the patient’s arm, compared to 132 patients who had balloon angioplasty, a procedure using a balloon to push open the sides of the collapsed blood vessels.

In a follow-up one year later, researchers found that more than twice as many patients in the stent group were able to use their dialysis access grafts compared to patients treated with only balloon angioplasty.

“Access graft failure and the need for repeated procedures to open these vessels represent a significant cost to our health care system as well as a significant physical and emotional toll on patients. This study by University of Maryland School of Medicine faculty shows our commitment to finding real solutions that will benefit patients and their families” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine.

This new study builds on Dr. Haskal’s previous research, published in the New England Journal of Medicine in 2010, that showed shorter term benefits of the stent to keep blood vessels open. That research found good results for the stent group compared to angioplasty after six months.  This latest research shows that benefit extends even longer.

“This controlled study proves that we can achieve durable long-term solutions for these patients, reducing the need for invasive procedures and improving their quality of life,” adds Dr. Haskal, who is editor in chief of the Journal of Vascular and Interventional Radiology.

This study was funded by Bard Peripheral Vascular, Inc., manufacturer of the Flair Endovascular stent graft.

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About the University of Maryland School of Medicine

Established in 1807, the University of Maryland School of Medicine is the first public medical school in the United States, and the first to institute a residency training program. The School of Medicine was the founding school of the University of Maryland and today is an integral part of the 11-campus University System of Maryland. On the University of Maryland's Baltimore campus, the School of Medicine serves as the anchor for a large academic health center which aims to provide the best medical education, conduct

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sboston@umm.edu

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