Endovascular stents in the management of dialysis vascular access

Endovascular Stents have become important tools in the management of the dialysis vascular access. Recent improvements in stent technology, and ease of placement, led to an increase in their use in the outpatient setting. The developments of the Nitinol stent with unique thermal memory properties, as well as the flexible stent-graft have been significant forward leaps. The classic indications for stent placement in the dialysis circuit include treatment of dialysis access stenosis, central vein stenosis, aneurysmal segments, and angioplasty-associated vascular rupture. The ability of endovascular stents to provide immediate and short-term benefit for the dialysis access is undisputed. However, there is uncertainty about their long-term benefits. In this Chapter, I first discuss general concepts pertaining to stent types, characteristics, indications, and technical matters during placement. I then expand on outcomes following their placement in certain specific locations to manage specific lesions within the dialysis vascular circuit. In doing so, I highlight the most relevant literature when available, shared personal experience when applicable, and referenced alternative surgical treatment options when feasible.