Efficiency of the Viabahn covered stent graft as salvage treatment for failing hemodialysis accesses.

Abstract

We evaluated the safety and efficacy of covered stent grafts (CSG) and in particular the Viabahn CSG for arteriovenous access salvage. A retrospective data review of all patients treated with Viabahn CSG placement for dysfunctional access between September 2018 and October 2024 in two hospital centers was performed. The primary outcome measured was the functional patency at 3 months. Secondary outcomes included technical success, midterm patency rates, major complications, need for and type of reinterventions, and overall patient mortality. We included 73 patients (53% males) in this study with a mean age of 65 ±14 years. Access salvage and functional patency after placement of a Viabahn CSG was achieved for 94% of patients at three months. During the median follow-up of 28 months (range, 3-80 months), the primary patency rates were 76%, 51%, and 48%, and the secondary patency rates were 100%, 100%, and 95% at 6, 12, and 18 months, respectively. A total of 15 patients developed clinically significant stent restenosis requiring at least one additional procedure, 14 patients had acute access thrombosis requiring thrombectomy and PTA, with involvement of the Viabahn CSG in 6 cases. The overall access patency rate and survival rate were respectively 93% and 91%. Access loss occurred in five patients, and seven patients died from other causes. The use of the Viabahn stent graft was associated with excellent technical success and a favorable long-term profile in terms of assisted-secondary patency. The device demonstrated sustained effectiveness over time, with no major adverse events such as stent migration, infection, or death, underscoring its high safety and reliability. These findings support the Viabahn as a highly effective and safe therapeutic option. However, larger prospective multicenter studies with extended follow-up are warranted to validate these outcomes further.