{"id":"38cc9e989b8f","type":"article","url":"https://hartvaat.nl/2026/12/01/longitudinale-geografische-miss-verhoogt-restenose-na-stentgraft-bij-dialyse-acc/","title":"Longitudinale geografische miss verhoogt restenose na stentgraft bij dialyse-access","title_en":"Geographic miss and stent graft restenosis in hemodialysis access.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":[],"journal":"Renal failure","doi":"10.1080/0886022X.2026.2717813","source_url":"https://doi.org/10.1080/0886022X.2026.2717813","authors":["Cheng-Wei Lien","Ming-Chien Hsieh","Mu-Yang Hsieh","Meng-Kan Chen","Chih-Cheng Wu"],"significance":4,"published":"2026-08-31","source_date":"2026-12-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"In a cohort of 203 patients with hemodialysis access, longitudinal geographic miss (LGM) — residual stenosis >30% within 5 mm of the stent edge — was strongly associated with early restenosis. LGM was linked to a 2.6- to 2.7-fold higher risk of losing stent graft and access primary patency at one year. The findings suggest that precise stent coverage is a modifiable procedural target to improve access durability, though prospective validation is required.","created":"2026-08-25T00:54:55Z","updated":"2026-08-25T00:54:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een cohort van 203 patiënten met een dialyse-access bleek dat een longitudinale geografische miss (LGM) — restenose >30% binnen 5 mm van de stentrand — sterk samenhangt met vroegtijdige restenose. LGM ging gepaard met een 2,6- tot 2,7-voudig hoger risico op verlies van stentgraft- en primaire access-patency na één jaar. De resultaten wijzen erop dat een nauwkeurige stentdekking een modificeerbare procedurele factor is om de levensduur van dialyse-accessen te verbeteren, al is prospectieve validatie nodig.","abstract_original":"Stent grafts are widely used to treat dysfunctional hemodialysis vascular access, yet restenosis remains common and its predictors are incompletely understood. We analyzed 203 unique patients who underwent stent graft implantation between 2018 and 2022 from a prospectively maintained database. Geographic miss was defined as inadequate lesion coverage or suboptimal stent sizing; longitudinal geographic miss (LGM) was defined as residual stenosis >30% within 5 mm of either stent edge. The outcomes were loss of stent graft patency and access primary patency, assessed using Kaplan-Meier analysis and Cox regression models. Among 203 patients, 81% had arteriovenous grafts and 19% had arteriovenous fistulas. One-year stent graft patency and access primary patency were 63.1% and 22.7%, respectively. In the primary exploratory multivariable model, LGM was associated with both loss of stent graft patency (HR 2.62, 95% CI 1.34-5.12) and loss of access primary patency (HR 2.76, 95% CI 1.50-5.05). Other factors associated with patency outcomes included diabetes mellitus, thrombosis presentation, vessel rupture or dissection, smaller stent diameter, and stent graft length. LGM remained associated with both outcomes in an additional clinically adjusted model. These findings suggest that LGM may represent a potentially modifiable procedural target, although prospective studies with standardized imaging follow-up and prospective validation are needed."}