Multiple bare metal stents placed in an upper arm arteriovenous fistula essentially converts a native fistula in to a stenula leads to loss of accessible venous segment for cannulation.
https://www.isn-online.org/hemodialysis/education-by-topic/hemodialysis/stenula#sigProGalleria308781aa16
Kidney Dialysis Outcomes Initiative and Society of Interventional Radiology recommends stents in peripheral venous lesions when
1. Peripheral transluminal angioplasty (PTA) has failed AND the lesion is surgically inaccessible
2. Surgery is contra-indicated
3. Rupture of vein after PTA
Common clinical practice is to place stents when there is
1. Elastic recoil leading to >30% residual stenosis post PTA
2. Vascular rupture during a procedure
3. High risk candidate for surgical intervention
4. Buys time with a failing access to avoid catheter placement
Problems with stents
1. Recurrent intra-stent lesions
2. Stenosis extends beyond the stent
3. Stent infection
4. Stent fractures/migration
Multiple bare metal stents placed in an upper arm arteriovenous fistula essentially converts a native fistula in to a stenula (shown in the figure above) leads to loss of accessible venous segment for cannulation.