FLUENCY® PLUS Endovascular Stent Graft for In-stent Restenosis (RESCUE)

• Superiority of the FLUENCY® PLUS Endovascular Stent Graft (following PTA) over PTA alone through six months in the treatment of in-stent restenotic lesions. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  ACPP is defined as the interval following the index intervention until the next access thrombosis or repeated intervention. ACPP ends with a reintervention anywhere within the access circuit, from the arterial inflow to the superior vena cava-right atrial junction. Venous rupture caused by PTA is not an ACPP failure unless achieving hemostasis also causes thrombosis.
• Non-inferiority of FLUENCY® PLUS Endovascular Stent Graft (following PTA) over PTA alone through 30 days in the treatment of in-stent restenonic lesions. [ Time Frame: 30 days ] [ Designated as safety issue: Yes ]

The primary purpose of this study is to demonstrate that the FLUENCY® PLUS Endovascular Stent Graft can effectively and safely treat in-stent restenotic lesions in the venous outflow of the AV access circuit of hemodialysis patients with either of the two predominant vascular access types - those with an AV graft and those with an AV fistula.

This study will compare the use of the FLUENCY® PLUS Endovascular Stent Graft (following PTA) to PTA alone.

• Device: Fluency Plus Endovascular Stent Graft
  Treatment of in-stent restenosis
• Device: PTA only
  Treatment of in-stent restenosis

• Experimental: Fluency
  Fluency Plus Endovascular Stent Graft
  Intervention: Device: Fluency Plus Endovascular Stent Graft
• Active Comparator: PTA only
  Intervention: Device: PTA only

Inclusion Criteria:

• Patient must voluntarily sign and date the Informed Consent Form (ICF) prior to collection of study data or performance of study procedures.
• Patient must be either a male or non-pregnant female ≥ 21 years of age with an expected lifespan sufficient to allow for completion of all study procedures.
• Patient must be willing to comply with the protocol requirements, including the follow-up procedures, and be contacted by telephone.
• Patient must have an AV access graft (implanted for ≥ 30 days) or mature fistula located in an arm, and must have undergone at least one successful dialysis session prior to the index procedure.
• Patient must have a previously-placed bare metal stent located in the venous outflow of the AV access circuit in which a ≥ 50% stenosis originates.
• The entire target lesion must be located in the restenosed bare metal stent and extend to no more than 3 cm outside of the bare metal stent.
• The target lesion must be ≤ 10 cm in length.
• After angiography, the operator must judge that the lesion is amenable to angioplasty.
• The reference vessel diameter at the restenosed bare metal stent must be between 5.0 mm and 12.0 mm.
• Additional stenotic lesions (≥ 50%) in the venous outflow that are > 3cm from the edge of the target lesion must be successfully treated (defined as < 30% residual stenosis) prior to the index procedure.

Exclusion Criteria:

• The target lesion has had a corresponding thrombosis treated within 7 days prior to the index procedure.
• The target lesion has a reference vessel diameter that is larger than 12.0 mm.
• The patient has an infected AV access graft/fistula or uncontrolled systemic infection.
• A pseudoaneurysm is present within the target lesion.
• The location of the target lesion would require that the FLUENCY® PLUS Endovascular Stent Graft be deployed across the elbow joint.
• The location of the target lesion would require that the FLUENCY® PLUS Endovascular Stent Graft be deployed at or across the segment of graft or fistula utilized for dialysis needle puncture (i.e., "cannulation zone").
• The location of the target lesion would require that the FLUENCY® PLUS Endovascular Stent Graft cross the cephalic arch (perpendicular portion of the cephalic vein in the region of the deltopectoral groove before its junction with the axillary vein).
• The location of the target lesion would require that the FLUENCY® PLUS Endovascular Stent Graft be placed in the Superior Vena Cava.
• The location of the target lesion would require that the FLUENCY® PLUS Endovascular Stent Graft is placed across an angle that is greater than 90 degrees.
• The restenosed bare metal stent is fractured, as verified by angiography per institution's standard of care.
• The patient has a known uncontrolled blood coagulation disorder.
• The patient has a known allergy or sensitivity to contrast media which cannot be adequately pre-medicated.
• The patient has a known hypersensitivity to nickel-titanium.
• The subject has another medical condition, which, in the opinion of the Investigator, may cause him/her to be non-compliant with the protocol, confound the data interpretation, or is associated with a life expectancy insufficient to allow for the completion of study procedures and follow-up.
• The patient is currently participating in an investigational drug or another device study that has not completed the study treatment or that clinically interferes with the study endpoints. Note: Studies requiring extended follow-up visits for products that were investigational, but have since become commercially available, are not considered investigational studies.