supera for the juxta-anastomotic avf stenosis...supera for the juxta-anastomotic avf stenosis...

Supera for the Juxta-anastomotic AVF Stenosis

Technical Tips and Tricks

Dr Shannon D. ThomasVascular Access SurgeonConjoint Senior Lecturer

University of New South WalesSydney, Australia

Disclosure

Speaker name:

Dr S. D. Thomas.......................................................................

I have the following potential conflicts of interest to report:

x Consulting: Abbott Vascular

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

JXAS stenosis can lead to loss of the AVF

JXAS stenosis frequency ranging from 43% 2 to 100%5 of all AVFs

If severe, can cause the AVF to remain small and immature

Can lead to problematic dialysis

Can cause thrombosis of the AVF and eventual loss

2. Falk et al. Treatment of ”swing point stenoses” in hemodialysis arteriovenous fistulae. Clinical Nephrology.

2003;60:35-41

5. Sivanesan S, How TV, Bakran A. Sites of stenosis in AV fistulae for haemodialysis access. Nephrology,

dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European

Renal Association 1999;14:118-20.

18. Clark TW, Cohen RA, Kwak A, et al. Salvage of nonmaturing native fistulas by using angioplasty.

Radiology 2007;242:286-92.

JXAS Primary Patency: 92.5% at 6 months, 59.8% at 12 months

JXAS Assisted Primary Patency 97.5% at 6 months, 92.9% at 12

months

JXAS Assisted Primary Patency 97.5% at 6 months, 92.9% at 12

months

JXAS Endovascular Re-Intervention rate .31/year

Supera can be used to change the anastomotic Shape

Pre-Stent JXAS Stenosis Post-Stent Supera JXAS

• Puncture mid forearm useable segment

• Ber2 and V18 wire to cross into radial inflow artery (Can be difficult)

• Predilatation is a mandatory

• Elongate stent in radial artery to deploy stent to radial artery diameter

• Pack stent through anastomosis and swing vein segment

Technical Tips

Deploy the stent to the radial artery diameter

Conclusion

JXAS Supera deployment can be challenging

Patency benefit to patient is pay off

Alllows for long term maintanence of an AVF

Thank you

Supera for the Juxta-anastomotic AVF Stenosis

Technical Tips and Tricks

Dr Shannon D. ThomasVascular Access SurgeonConjoint Senior Lecturer

University of New South WalesSydney, Australia