Regarding 'Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial'.

摘要

David Shemesh et al reported significantly better primary patency rates for covered stents compared to bare stents in early recurring stenoses of the final arch of the cephalic vein. Although the authors acknowledge in the Discussion that these "stents can cause occlusion of the axillary/subclavian vein" so "that the arm is no longer available for (a new) arteriovenous access construction", we disagree when they say that this is a rare phenomenon. From our previous experience with stents in this location, even stents not clearly protruding into the axillary/subclavian vein can cause stenosis or occlusion, which then precludes any further creation of a new ipsilateral vascular access. There are, to date, no criteria to help predict this severe complication. We have previously emphasized the drawbacks of axillary-subclavian stents in a published letter.