FLUENCY® PLUS Endovascular Stent Graft for In-stent Restenosis

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 Arteriovenous (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 Percutaneous Transluminal Angioplasty (PTA)) to PTA alone.

Eligibility Criteria:
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.